Author Year Country | Scope of study | Study design | Population (n) | Study groups; Intervention and control (n = no. of DIEPs/TRAMs) | Definition of venous congestion | Recipient vessel | Outcomes | Directnessa | Study limitationsa | Precisiona |
---|---|---|---|---|---|---|---|---|---|---|
Al-Dhamin, Canda 2014 [27] | Evaluation of the retrograde limb of the internal mammary vein as a second recipient vein | Non-randomised study (retrospective) with controls | P1: 48 DIEPs (38 pats) | I1: 17 C: 31 | NR | The DIEV was anastomosed to the proximal IMV and the SIEV was anastomosed to the distal IMV | O1. Flap complications | − | + ? | − |
Al Hindi, 2019, France [28] | Analyse the centre’s use of SIEVs | Non-randomised study (retrospective) with controls | P1: 198 DIEPs (183 pats) | I1: 15 I2: 2 C: 181 | Blueish discoloration and increased capillary refill time (> 3 s) | SIEV 11/17 Second DIEV 6/17 Recipient vessels: CV 8 IMV 4 LMV 2 CSV 2 TDV 1 | O1. Flap complications O3. LOS O4. Operative time | - | - | - |
Ali, 2010, Taiwan [29] | Investigation of compilations in intraoperatively congested DIEPs | Non-randomised study (retrospective) with controls | P1: 151 DIEPs | I1: 14 I2: 7 C: 130 | ‘A purplish or plethoric coolness of the flap associated with brisk capillary refill (< 1 s) and rapid and dark venous bleeding on puncture, despite a patent venous anastomosis’ | SIEV Second DIEV Recipient vessels: IMV EJV TDV ± VG | O1. Flap complications O3. LOS | − | − | ? |
Akita, 2018, Japan [30] | Pilot-testing of a method to detect venous congestion intraoperatively | Non-randomised study (prospective) with controls | P1: 70 DIEPs (67 pats) | I1: 8 C: 62 | NA | Ipsilateral SIEV to LTV (n = 3) DIEV (n = 2) | O6. Strategies | − | + ? | ? |
Ayestaray, 2016, France [31] | Investigation of the effect of venous supercharging on complication | RCT | P1: 52 DIEPs | I3: 29 C: 23 Patients randomised to supercharging or not supercharging | NR | Ipsilateral SIEV to TAV | O1. Flap complications O4. Operative time O5. Operative takebacks | ? | + | − |
Bartlett, 2018, USA [32] | Description of centre’s algorithm for intraoperative salvage of congested flaps | Case series (retrospective) | P1: 67 DIEPs (38 pats) C: 172 DIEPs (100 pats) | I1: 40 | • Brisk capillary refill (< 1.5 s) • Red/purple hue • Dilated/ tense SIEV • Brisk bleedning during flap trimming or de-epithelialisation | 32 SIEV to DIEV 5 SIEV to IMV | O1. Flap complications O4. Operative time | − | − | − |
Bast, 2016 [33] | Investigation of the ratio of the sub- and supra-scarpal fat layers, the number of deep system perforators, and of the SIEV diameter and if indications for SIEV dissection can be predicted by these factors | Case series (retrospective) | P2: 50 women (100 hemiabdomens) | I4: 50 CTA | NA | NA | O6. Strategies | − | + ? | ? |
Beier, 2013, German [34] | Investigation of assess the potential role for intra-operative CLDS for intra-operative decision-making | Case series (prospective) | P1: 25 DIEPs or muscle sparing TRAMs | I4: CTA (preop), Combined lased Doppler spectrophotometry (CLDS) (intraop) | NA | NA | O6. Strategies | − | + ? | ? |
Blondeel, 2000, Belgium [9] | Comparison of venous congestion in DIEPs vs. TRAMs, suggestion of strategy for dealing with venous congestion and investigation of why venous congestion occur more frequently in zone IV of a DIEP flap | Non-randomised study (retrospective) with controls and case series (prospective) of cadavaers | P1: 249 DIEPs (214 pats) | I1: 5 C: 245 | ‘Severe diffuse venous congestion that involved the whole flap. Particularly large SIEV (> 1.5 mm)’ | NR | O6. Strategies | − | + ? | ? |
Boutros, 2013, USA [35] | Investigate the outcome of the centre’s routine use of venous augmentation | Non-randomised study (retrospective) with controls | P1: 352 DIEPs (192 pats) | I3 (?): 311 C: 42 NR how the patients were allocated to the two groups. Authors describe their use of venous supercharging was routinely used | Ultrasound diagnosis | The largest superficial vein to the more medial IMV or to the perforator of IMV | O1. Flap complications O5. Surgical takebacks | − | − | |
Davis, 2018, UK [18] | Correlation of preoperative CTA findings with postoperative venous congestion to predict patients at risk of congestion | Non-randomised study (prospective) with controls | P1: 240 DIEPs | I1 + 2: 13 C: 227 I4: CTA | ‘Sufficient clinical evidence necessitating a salvage procedure’ | SIEV to DIEV (SOS-technique) Retrograde IMV Second v. comitantis of IMV CV TV | O6. Strategies | − | + ? | ? |
Dortch, 2018, USA [36] | Investigate venous characteristics associated with SIEV augmentation | Non-randomised study (retrospective) with controls | P1. 99 DIEPs or muscle sparing TRAMs | I1: 29 I4: Ferumoxytol-enhanced magnetic resonance angiography C: 73 | NR | NR | O6. Strategies | − | + ? | ? |
Enajat, 2010, Australia [37] | Comparison of one and two veins for drainage | Non-randomised study (retrospective) with controls | 564 DIEPs (501 pats) | I1: 291 C: 273 | ‘Brisk capillary refill or bleeding or deep blue colour of the flap or draining blood’ | SIEV (92%) or second DIEV (8%) to CV 83% IMV 10% CSV 4% TDV 4% | O1. Flap complications O4. Operative time | − | ||
Eom, 2011, South Korea [38] | Review of centre’s experiences and comparison of different recipient veins | Non-randomised study (retrospective) with controls | P1: 153 DIEPs and TRAMs | I2: 45 C: 108 | ‘Signs of congestion’ | SIEV to 31 LTVs 10 branches of TAV 4 perforator of IMV The contralateral SIEV was used as VG in 4 cases | O1. Flap complications O5. Take backs | − | − | − |
Galanis, 2014, USA [39] | Description of centre’s strategies to handle intraoperative venous congestion | Description of approach | NA | NA | NA | NA | O6. Strategies | − | − | − |
Huang, 2022, USA [40] | Investigation of risk factors for venous congestion | Non-randomised study (retrospective) with controls | 455 DIEPs (258 pats) | I1: 5 I2: 3 I4: CTA C: 447 | ‘Flap engorgement and colour change’ | NR | O6. Strategies | ? | + ? | ? |
Katz, 2010, USA [41] | Classification of clinically relevant CTA scenarios | Case series (prospective) | P2: 172 hemiabdomens (86 pats) | P4: CTA | NA | NA | O6. Strategies | − | + ? | ? |
La Padula, 2016, France [42] | Assesment of the retrograde IMV as a recipient vessel | Non-randomised study (retrospective) with controls | P1: 74 DIEPs | I2: 36 C: 38 | Clinical signs of venous congestion | SIEV/second DIEV to retrograde limb of IMV | O1. Flap complications O3. LOS O5. Operative takebacks | − | + ? | ? |
Lee, 2013, South Korea [43] | Evaluation of the association between ischaemic time and fat necrosis in DIEP | Non-randomised study (retrospective) with controls | P1: 86 DIEPs | P1: 18 C: 68 | NR | O1. Flap complications | − | ? | ? | |
Lundberg, 2006, Sweden [44] | Evaluation of 50 consecutive DIEPs to develop a strategy to avoid complications | Non-randomised study (retrospective) with controls | P1: 50 DIEPs | P1:3 P2: 3 C:44 | Capillary refill < 2 s | SIEV to CV | O6. Strategies | − | − | − |
Nedomansky, 2018, Austria [45] | Evaluation whether SIEV dissection increases the risk for abdominal seroma | Non -randomised study (retrospective) with controls | P1: 100 DIEPs | 39 pat with SIEV dissection (29 unilateral and 10 bilateral) C: 61 | ‘Livid discoloration of the flap in combination with an erected SIEV stump’ | NR | O2. Donor site complications O3. LOS | − | ? + | ? |
Ochoa, 2013, USA [46] | Determination of the incidence of flap morbidity following venous augmentation among intraoperatively congested DIEP flaps | Non-randomised study (retrospective) with controls Narrative review | P1: 87 DIEPs (81 patients) | I1: 87 DIEPs (81 pats) C: 629 DIEPs (418 pats) | ‘Brisk capillary refill. Cutaneous discoloration that improves promptly when release of venous blood through the SIEV’ | 59 SIEV 28 DIEV To 50 IMV 24 IMV perforators 6 DIEV 5 LTV 2 TDV 15 VG | O1. Flap complications O3. LOS O4. Operative time O6. Strategies | − | − | − |
Rothenberger, 2013, Germany [47] | Investigate the venous drainage of the DIEP flap | Case series (prospective) | P1: 19 DIEPs | I4: Clamping of ipsilateral and contralateral and both SIEVs intraoperatively to determine the efficiency of venous outflow | NA | NA | O6. Strategies | − | + ? | ? |
Rubino, 2009, Italy [48] | ‘Investigation of the correlation between flow rate and size in perforator flaps and, estimation of the minimum diameter of the perforating vein needed to drain flaps of given weights.’ | Case series (prospective) | P1: 19 DIEPs | I4: Echo-colour-Doppler | NA | NA | O6. Strategies | − | + ? | ? |
Xin, 2012, China [49] | Investigation of the efficacy of venous augmentation Presentation of a new technique | Non-randomised study (retrospective) with controls | P1: 79 DIEPs | I1: 32 C: 47 I4: Blood pressure measurements in anastomoses | Large flaps and/or clinical signs | SIEV to TDV, LTV, IMV, or DIEV | O1. Flap complications O4. Operative time | − | − | − |
Sadik, 2013, USA [50] | Definition of predictors for a superficially dominant venous system | Non-randomised study (prospective) with controls | P1: 39 DIEPs | I1: 6 C: 33 I4: CTA—measurement of the SIEV diameter preoperatively. The diameter was also measured intraoperatively | NR | NR | O6. Strategies | + ? | ? | |
Santanelli, 2015, Italy [51] | Investigation of predictive and protective factors for perfusion related complication | Non-randomised study (retrospective) with controls | P1: 287 DIEPs | I1: 173 C:74 | NR | NR | O1. Flap complications | − | + ? | ? |
Schaverien, 2010, UK [52] | Investigation of the relationship between presurgical venous pattern analysed with MRA and venous compromises | Case series (retrospective) | P1: 54 DIEPs | I4: Preoperative contrast-enhanced magnetic resonance angiography | NR | NA | O6. Strategies | − | + ? | ? |
Smit, 2010, Sweden (multicentre) [53] | Investigation of pressure in the SIEV before and after flap dissection and correlation to venous congestion | Case series (prospective) | P1: 26 DIEPs | I4: Measurement of venous pressure | NR | NR | O6. Strategies | − | + ? | ? |
Svee, 2023, Sweden [54] | Investigation of arm lymphoedema after the usage of CV | Case series (retrospective) | P1: 54 DIEPs | I1: 27 C: 27 | NR | SIEV to CV | O2. Donor site morbidity | − | + ? | + ? |
Tokumoto, 2019, Japan [55] | Investigation of whether CV is equivalent to SA and LTV for superdrainage | Non-randomised study (retrospective) with controls | P1: 88 DIEPs (88 pats) | I1: 45 C: 43 | Clinical signs of venous congestion and/or bleeding from the SIEV after anastomosis | SIEV to 22 SA 16 LT 7 CV The extra anastomosis was performed in patients where the IMV diameter was smaller than that of the DIEV | O1. Flap complications O2. Donor site complications O4. Operative time O5. Operative take backs O6. Strategies | − | − | ? |
Unukovych, 2016, Sweden [56] | Evaluate perioperative predictors of complications and reoperations in DIEP | Case series (retrospective) | P1: 503 DIEPs (433 pats) | I1: 211 C: 292 | ‘Discretion of surgeon’ | O1. Complications | − | ? | ? | |
Varnava, 2023, Germany [57] | Review of centres use of SIEV | Case series (retrospective) | P1: 150 DIEPs (107 pats) | I1: 4 C: 146 | NR | NR | O1. Complications O5. Operative take backs | − | − | − |
Vijayasekaran, 2017, USA [58] | Analyse of the centres use of SIEV and retrograde IMV Description of algorithm for routine use of SIEV | Non-randomised study (retrospective) with controls Routine venous augmentation -two consecutive cohorts | P1: 60 DIEPs | I3: 30 C: 30 Two consecutive series | NA | SIEV to the retrograde IMV | O1. Flap complications O5. Operative take backs O6. Strategies | ? | + | ? |
Wagels, 2015, Australia [59] | Investigation of signs on CTA that can predict venous congestion | Non- randomised study (retrospective) with controls | P1: 124 DIEPs/TRAMs (96 pats) | I4: CTA | NA | NR | O6. Strategies | − | + ? | ? |
Zhu, 2023, Republic of Korea [60] | Investigation of the clinical efficacy of the use of SIEV using indocyanine green intraoperatively | Non- randomised study (retrospective) | P1: 62 ms-TRAMS, 6 DIEPs | I4: CTA and indocyanine green | NA | NR | O6. Strategies | − | + ? | ? |