D62. Incidence of Patent Retrograde Flow through Vena Comitans in DIEP Flaps

PURPOSE:Venous congestion of deep inferior epigastric perforator (DIEP) flaps can be resolved with intra-flap anastomosis to the superficial inferior epigastric vein (SIEV). This requires retrograde venous flow through the vena comitans (VC) of the DIEP. One-way valves can block this flow unless the VCs share communicating branches. Our study determines the incidence of patent retrograde flow through DIEPs. METHODS: In patients receiving DIEP flap reconstruction, communication between VCs was tested using a heparin flush. Luminal diameter of each VC was recorded. Flow patterns were compared using Chi-Squared goodness-of-fit. RESULTS: Thirty-seven DIEP flaps from 20 patients were studied. Each DIEP showed patent VC connections, except for two that only contained a single VC. Of the remaining 35 flaps, the average luminal VC diameter was 2.38mm, commonly with one larger VC. Sixty-nine percent of perforators had communicative flow bidirectionally, between both VCs. Twenty-six percent had flow from the smaller VC to the larger, and 2 flaps had flow from the larger to the smaller (p=0.000). CONCLUSION: Utilization of a heparin flush identified patent VC communication prior to SIEV anastomosis. Retrograde venous flow through the DIEP is a reliable salvage pathway, though the smaller vena comitans is a more dependable anastomotic option.