Prophylactic Superdrained Deep Inferior Epigastric Perforator Flap: Systematic Review of Survival and Morbidity
In brief
Two-vein DIEP drainage had congestion rates up to 13%, versus 55% with one
In a review of 17 studies covering 2,964 breast reconstruction flaps, venous congestion ranged from 0% to 13% with two-vein drainage, compared with 2.6% to 55.1% with one vein. Other vein-related complications were also less frequent in dual-vein groups, while hematoma and infection rates were similar. These study ranges are not pooled estimates, so the size of any benefit remains uncertain.
- Journal
- Plastic and reconstructive surgery. Global open (Q2)
- Published
- 20 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Pamela Brazeau-Porrello, Ayden Watt, Éli Blais, Michel A Danino, Johnny I Efanov
- PMID
- 42903308
- DOI
- 10.1097/GOX.0000000000008185
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 25 October 2026): DIEP flap venous drainage and flap survival complications
Abstract
BACKGROUND: The deep inferior epigastric perforator (DIEP) flap is considered the gold standard option for autologous tissue reconstruction after total mastectomy. To minimize complication rates, such as venous congestion, adding a second venous anastomosis to support the flap (venous superdrainage) has gained popularity, although the degree of clinical benefit remains unclear. This study presents a systematic review to evaluate the complication profiles of dual venous anastomosis DIEP flap breast reconstruction. METHODS: A systematic search of PubMed, Embase, and MEDLINE was performed to identify studies evaluating venous superdrainage in DIEP flap breast reconstruction. Seventeen studies were included, comprising 2964 flaps (1536 single-vein and 1428 dual-vein). Postoperative complications were extracted and reported descriptively, with direct comparisons highlighted when available. RESULTS: Across 17 studies, including 2964 DIEP flaps, dual-venous anastomosis was associated with lower rates of venous-related complications. In the dual-vein group, complication rates were low, including venous congestion (0%-13%), venous thrombosis (0%-2.7%), total flap loss (0%-8.7%), fat necrosis (0%-17.4%), and partial flap loss (0%-13.3%). In contrast, single-vein cohorts demonstrated higher rates of key complications, particularly venous congestion (2.6%-55.1%), venous thrombosis (1.8%-18.8%), fat necrosis (4.9%-48.2%), partial flap loss (up to 44.8%), and total flap loss (up to 17.2%). Hematoma and infection rates were comparable between groups. CONCLUSIONS: Optimizing clinical outcomes after DIEP flap breast reconstruction remains an important clinical goal. These results suggest that prophylactic supercharging of the DIEP flap with 2 veins may be associated with lower complication rates in several comparative studies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.