Objectives:
The deep inferior epigastric artery perforator(DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bi-pedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage.
Methods:
We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bi-pedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery(DIEA) and accompanying veins(DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded.
Results:
On the right side, the mean±SD diameter of the DIEA was 4.67±0.58 mm, that of the first DIEV(DIEV1) was 4.24±0.85 mm, and that of the smaller DIEV2(72.22%) was 3.08±0.80 mm. The mean pedicle length was 11.94±1.95 cm. On the left side, the diameter of the DIEA was 4.65±0.54 mm, that of the DIEV1 was 4.24±0.82 mm, and that of the DIEV2(64.81%) was 3.07±0.80 mm. The pedicle length was 11.84±2.09 cm. Comparison of the right side and left side diameters and pedicle lengths obtained showed no significant differences(p>0.05). Diameters were larger in both sides when comparing DIEV1 to DIEV2(p<0.001). Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed.
Conclusions:
There was a strong correlation between the size of DIEA and DIEV on both sides. The low vein congestion rate observed reveals adequate venous drainage was achieved in the DIEV system for DIEP free-flap reconstruction. Sufficient deep inferior epigastric vessel size, over 60% flaps with an additional DIEV and pedicle length should allow for comfortable microsurgery and lower complications.

Download