Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap

  • Park, Seong Oh (Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine) ;
  • Imanishi, Nobuaki (Department of Anatomy, Keio University College of Medicine) ;
  • Chang, Hak (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
  • Published : 2022.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

Keywords

References

  1. Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975;56(03):243-253 https://doi.org/10.1097/00006534-197509000-00001
  2. Carramenha e Costa MA, Carriquiry C, Vasconez LO, Grotting JC, Herrera RH, Windle BH. An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap. Plast Reconstr Surg 1987;79(02):208-217 https://doi.org/10.1097/00006534-198702000-00010
  3. Rozen WM, Pan WR, Le Roux CM, Taylor GI, Ashton MW. The venous anatomy of the anterior abdominal wall: an anatomical and clinical study. Plast Reconstr Surg 2009;124(03):848-853 https://doi.org/10.1097/PRS.0b013e3181b037a2
  4. Schaverien M, Saint-Cyr M, Arbique G, Brown SA. Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 2008;121(06):1909-1919 https://doi.org/10.1097/PRS.0b013e31817151f8
  5. Kita Y, Fukunaga Y, Arikawa M, Kagaya Y, Miyamoto S. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: a retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg 2020;73(05):870-875 https://doi.org/10.1016/j.bjps.2019.11.028
  6. Kim BJ, Choi JH, Kim TH, Jin US, Minn KW, Chang H. The superficial inferior epigastric artery flap and its relevant vascular anatomy in Korean women. Arch Plast Surg 2014;41(06):702-708 https://doi.org/10.5999/aps.2014.41.6.702
  7. Reardon CM, O'Ceallaigh S, O'Sullivan ST. An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 2004;57(06):515-519 https://doi.org/10.1016/j.bjps.2004.04.019
  8. Lie KH, Barker AS, Ashton MW. A classification system for partial and complete DIEP flap necrosis based on a review of 17,096 DIEP flaps in 693 articles including analysis of 152 total flap failures. Plast Reconstr Surg 2013;132(06):1401-1408 https://doi.org/10.1097/01.prs.0000434402.06564.bd
  9. Kim DY, Lee TJ, Kim EK, Yun J, Eom JS. Intraoperative venous congestion in free transverse rectus abdominis musculocutaneous and deep inferior epigastric artery perforator flaps during breast reconstruction: a systematic review. Plast Surg (Oakv) 2015;23(04):255-259
  10. Sbitany H, Mirzabeigi MN, Kovach SJ, Wu LC, Serletti JM. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconstr Surg 2012;129(04):809-815 https://doi.org/10.1097/PRS.0b013e318244222d
  11. Wechselberger G, Schoeller T, Bauer T, Ninkovic M, Otto A, Ninkovic M. Venous superdrainage in deep inferior epigastric perforator flap breast reconstruction. Plast Reconstr Surg 2001;108(01):162-166 https://doi.org/10.1097/00006534-200107000-00026
  12. Boutros SG. Double venous system drainage in deep inferior epigastric perforator flap breast reconstruction: a single-surgeon experience. Plast Reconstr Surg 2013;131(04):671-676 https://doi.org/10.1097/PRS.0b013e31828189e6
  13. Enajat M, Rozen WM, Whitaker IS, Smit JM, Acosta R. A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: investigating the effect on venous congestion and flap survival. Microsurgery 2010;30(03):185-191 https://doi.org/10.1002/micr.20712
  14. Xin Q, Luan J, Mu H, Mu L. Augmentation of venous drainage in deep inferior epigastric perforator flap breast reconstruction: efficacy and advancement. J Reconstr Microsurg 2012;28(05):313-318 https://doi.org/10.1055/s-0032-1311688
  15. Imanishi N, Nakajima H, Minabe T, Chang H, Aiso S. Anatomical relationship between arteries and veins in the paraumbilical region. Br J Plast Surg 2003;56(06):552-556 https://doi.org/10.1016/S0007-1226(03)00207-8
  16. Schaverien MV, Ludman CN, Neil-Dwyer J, et al. Relationship between venous congestion and intraflap venous anatomy in DIEP flaps using contrast-enhanced magnetic resonance angiography. Plast Reconstr Surg 2010;126(02):385-392 https://doi.org/10.1097/PRS.0b013e3181de2313
  17. Lie KH, Taylor GI, Ashton MW. Hydrogen peroxide priming of the venous architecture: a new technique that reveals the underlying anatomical basis for venous complications of DIEP, TRAM, and other abdominal flaps. Plast Reconstr Surg 2014;133(06):790e-804e https://doi.org/10.1097/PRS.0000000000000228
  18. Eom JS, Kim DY, Kim EK, Lee TJ. The low DIEP flap: an enhancement to the abdominal donor site. Plast Reconstr Surg 2016;137(01):7e-13e https://doi.org/10.1097/PRS.0000000000001867
  19. Blondeel PN, Arnstein M, Verstraete K, et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 2000;106(06):1295-1299 https://doi.org/10.1097/00006534-200011000-00009
  20. Park SO, Chang H, Imanishi N. Differences of the midline-crossing venous drainage pattern in supraumbilical and infraumbilical regions: angiographic study using fresh cadavers. PLoS One 2020;15(11):e0242214 https://doi.org/10.1371/journal.pone.0242214
  21. Lee KT,Mun GH. Volumetric planning using computed tomographic angiography improves clinical outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg 2016;137(05):771e-780e https://doi.org/10.1097/PRS.0000000000002045
  22. Chang H, Ha JH, Park SO. Two-dimensional X-ray angiography to examine fine vascular structure using a silicone rubber injection compound. J Vis Exp 2019;(143):
  23. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009;124(05):1529-1544 https://doi.org/10.1097/PRS.0b013e3181b98a6c
  24. Park SO, Cho J, Imanishi N, Chang H. Effect of distal venous drainage on the survival of four-territory flaps with no pedicle vein: results from a rat model. J Plast Reconstr Aesthet Surg 2018;71(03):410-415 https://doi.org/10.1016/j.bjps.2017.09.001
  25. Rothenberger J, Amr A, Schiefer J, Schaller HE, Rahmanian-Schwarz A. A quantitative analysis of the venous outflow of the deep inferior epigastric flap (DIEP) based on the perforator veins and the efficiency of superficial inferior epigastric vein (SIEV) supercharging. J Plast Reconstr Aesthet Surg 2013;66(01):67-72 https://doi.org/10.1016/j.bjps.2012.08.020
  26. Kai K, Satoh S, Watanabe T, Endo Y. Evaluation of cholecystic venous flow using indocyanine green fluorescence angiography. J Hepatobiliary Pancreat Sci 2010;17(02):147-151 https://doi.org/10.1007/s00534-009-0111-9
  27. Nasser A, Fourman MS, Gersch RP, et al. Utilizing indocyanine green dye angiography to detect simulated flap venous congestion in a novel experimental rat model. J Reconstr Microsurg 2015;31(08):590-596 https://doi.org/10.1055/s-0035-1558869
  28. Yu YH, Ghorra D, Bojanic C, Aria ON, MacLennan L, Malata CM. Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction. Arch Plast Surg 2020;47(05):473-482 https://doi.org/10.5999/aps.2019.01319