Atlas of recipient vessels for the superficial venous system of DIEP-flaps - a systematic literature review and clinical practice review

Clinical Snapshot

Key Findings

• Effect Size: Not applicable - descriptive systematic review

• Primary Outcome: Identification of recipient vessel options for SIEV anastomosis

• Nnt Or Sensitivity: Internal mammary vein most frequently reported recipient vessel

• Confidence Interval: Not reported

Clinical Application

Multiple recipient vessel options available, with institutional experience supporting cephalic vein as reliable option Relevant to Australian plastic surgery practice, particularly in major centres performing microsurgical breast reconstruction. No specific PBS or TGA implications as this relates to surgical technique rather than devices or medications Plastic surgeons performing DIEP flap breast reconstruction with consideration for superficial venous supercharging

Abstract

BACKGROUND: Venous congestion contributes to up to 40% of failures in abdominally based free flaps, underscoring the importance of optimising superficial venous drainage in deep inferior epigastric perforator (DIEP) flap breast reconstruction. The superficial inferior epigastric vein (SIEV) is sometimes essential to flap outflow. This systematic review investigates the choice of recipient vessels for superficial venous supercharging. METHODS: A systematic review was performed according to a PROSPERO-registered protocol (CRD42022353591) and PRISMA guidelines. PubMed, CINAHL, Embase, and the Cochrane Library were searched for studies describing SIEV recipient vessels or vessel-selection algorithms. Extracted data included study design, recipient vessel, graft use, and decision strategies. A clinical practice review was also conducted at Sahlgrenska University Hospital, where prophylactic SIEV-cephalic vein (CV) anastomosis has been used for over two decades. RESULTS: Twenty-nine studies were included. Reported recipient vessels outside the flap comprised, for example, the following veins: internal mammary, cephalic, thoracoacromial, and thoracodorsal. Intra-flap options included anastomoses to branches or the caudal end of the deep inferior epigastric vein. Three studies described interposition grafts, and eight proposed selection algorithms, with no consensus. The internal mammary vein was most frequently used. At Sahlgrenska, a short axillary-fold incision provides consistent and cosmetically favourable access to the CV, adding minimal operative time. CONCLUSION: Recipient vessel selection for SIEV anastomosis remains highly variable in the literature. Long-term institutional experience supports the CV as a reliable and versatile option. Prospective studies are needed to evaluate outcomes.

References

1. 1.Hansson, E., & Löfstrand, J. (2026). Atlas of recipient vessels for the superficial venous system of DIEP-flaps - a systematic literature review and clinical practice review. Journal of Plastic Surgery and Hand Surgery, 61, 45988. https://doi.org/10.2340/jphs.v61.45988