Purpose: To study the incidence and management of various microvascular complications associated with the deep inferior perforator flaps (DIEP).

Materials and Methods: A prospective study at Mayo Clinic between January 2002 to April 2003 involved 92 DIEP flaps which were used primarily for breast reconstruction. Patients had an average age of 45 years and follow-up time of 10 months. Microvascular anastomoses were done to thoracodorsal vessels in 32 flaps and to internal mammary in 60 flaps. Intraoperative and postoperative arterial and venous complications were studied and managed accordingly.

Results: No arterial problem developed. Overall venous congestion occurred in 15% of the flaps. Postoperative, venous obstruction at 3.3% resulted in one (1%) lost flap, which had its intraoperative bypass thrombosed during the post op time. Intraoperative venous congestion was found in 12% of the flaps, but only 5.4% had persistent congestion that required management with the superficial epigastric vein bypass (SIEV). The remaining venous congestive flaps spontaneously decompressed intraoperatively without intervention and uneventful flap healing.

Conclusions: Intraoperative venous congestion of DIEP flaps occurs in 12%, but only the persistently congested flaps (5.4%) requires a venous bypass using the SIEV. The spontaneous intraoperative resolution of venous congestion demonstrates the extensive capacity of venosomes to interconnect.