Intraoperative superficial inferior epigastric vein preservation for venous compromise prevention in breast reconstruction by deep inferior epigastric perforator flap.

Autor: Al Hindi A; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France. Electronic address: alhindi_a@yahoo.com., Ozil C; Clinique Blomet, 136 bis, rue Blomet, 75015 Paris, France., Rem K; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France., Rausky J; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France., Moris V; Plastic and Reconstructive department, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France., Guillier D; Plastic and Reconstructive department, CHU de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France., Binder JP; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France., Revol M; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France., Cristofari S; Plastic, Reconstructive and Aesthetic Surgery Department, AP-HP, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Jazyk: angličtina
Zdroj: Annales de chirurgie plastique et esthetique [Ann Chir Plast Esthet] 2019 Jun; Vol. 64 (3), pp. 245-250. Date of Electronic Publication: 2018 Oct 13.
DOI: 10.1016/j.anplas.2018.09.004
Abstrakt: Objective: The aim of this study was to analyze our technique of intraoperative venous compromise management based on conservation of the superficial inferior epigastric vein (SIEV), and to undertake a retrospective review of our series of breast reconstructions by deep inferior epigastric perforator (DIEP) flap, followed by a review of other techniques reported in the literature.
Materials and Methods: This retrospective study involves 198 breast reconstructions by DIEP flap performed between January 2010 and September 2017. Our surgical technique is related in detail, with a focus on venous compromise management. Operative time, re-intervention rate, hospital stay, and complications were all noted and analyzed, and a literature review dealt with other techniques of prevention and management of flap venous congestion.
Results: Among breast reconstructions by DIEP, 7.5% contained an episode of intraoperative venous compromise, as opposed to 6.5% postoperatively. The SIEV was used in 65% of cases of venous congestion. In our series, 15.1% of cases presented postoperative complications, and we observed a 2.5% flap failure rate (2%: venous thrombosis; 0.5%: arterial thrombosis). In all patients for whom venous drainage augmentation was performed, the flaps survived without partial loss. While average length of hospital stay in the group having undergone intraoperative secondary anastomosis was 7.5 days, in the group having undergone postoperative secondary anastomosis, it was 13.5 days.
Conclusion: In cases of intraoperative venous congestion, while a second venous anastomosis may immediately increase duration of an initial intervention by 1hour and 45minutes, it is nonetheless likely to pronouncedly decrease need for surgical revision, cases of failure, rate of partial necrosis and overall hospital stay.
(Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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