{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:53:46Z","timestamp":1784573626558,"version":"3.55.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival.<\/jats:p><jats:p>\n          Methods\u2003This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed.<\/jats:p><jats:p>\n          Results\u2003Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p\u2009=\u20090.005), as was the rate of flap loss (p\u2009=\u20090.006) and reoperation due to venous thrombosis (p\u2009=\u20090.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p\u2009=\u20090.01).<\/jats:p><jats:p>\n          Conclusion\u2003Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.<\/jats:p>","DOI":"10.1055\/a-2181-7034","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T23:07:30Z","timestamp":1695769650000},"page":"379-383","source":"Crossref","is-referenced-by-count":7,"title":["The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5470-452X","authenticated-orcid":false,"given":"Esther Mihwa Oh","family":"Choi","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renan Diego Am\u00e9rico","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Montag","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago","family":"Ueda","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Yoshikazu","family":"Okada","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Mendon\u00e7a","family":"Munhoz","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio de Freitas","family":"Busnardo","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Gemperli","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas, University of S\u00e3o Paulo School of Medicine, S\u00e3o Paulo, Brazil"},{"name":"Department of Plastic Surgery, S\u00e3o Paulo State Cancer Institute, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/SAP.0b013e318221b578","article-title":"Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction","volume":"69","author":"A O Momoh","year":"2012","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref2","first-page":"423","article-title":"The free abdominoplasty flap and its use in breast reconstruction. 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Okada","year":"2017","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1055\/s-0040-1716349","article-title":"Different hydraulic constructs to optimize the venous drainage of DIEP flaps in breast reconstruction: decisional algorithm and review of the literature","volume":"37","author":"M Pignatti","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/PRS.0000000000000271","article-title":"Microvascular lifeboats: a stepwise approach to intraoperative venous congestion in DIEP flap breast reconstruction","volume":"134","author":"C Galanis","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"767e","DOI":"10.1097\/PRS.0b013e318267d995","article-title":"Double-pedicled abdominal free flap using an entirely new microvascular combination of DIEP and SIEA vascular pedicles for unilateral breast reconstruction: a novel addition to the Hamdi classification","volume":"130","author":"N G Rabey","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref18","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1016\/j.bjps.2007.02.016","article-title":"Double-pedicle abdominal perforator free flaps for unilateral breast reconstruction: new horizons in microsurgical tissue transfer to the breast","volume":"60","author":"M Hamdi","year":"2007","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"03","key":"ref19","first-page":"179","article-title":"Stacked abdominal flap for unilateral breast reconstruction","volume":"31","author":"A Murray","year":"2015","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive 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