That DIEP flaps can be troublesome is not news and many descriptions exist trying to circumvent these problems. The most common problem is venous congestion in the flap and this paper presents an ingenious method of anticipating and forestalling such a problem should it occur. In their technique, the authors preserve some of the cephelad length of the deep epigastric vein, beyond the perforating vessels and anastomose this to a superficial vein that they have also preserved. This anastomosis is performed if there is evidence of congestion and relieves it. This is one of many techniques used by various operators to eliminate this problem and it strikes me as a simple, forward thinking solution.

The superficial outside-flap shunt (SOS) technique for deep inferior epigastric perforator flap salvage.
Davies AJ, O'Neill JK, Wilson SM.
Share This