Consistent position of the superficial inferior epigastric vein (SIEV) during deep inferior epigastric perforator (DIEP) flap raise: A radiological analysis

The superficial inferior epigastric vein (SIEV) is often harvested and preserved with a deep inferior epigastric perforator (DIEP) flap for potential anastomosis in cases where venous congestion is anticipated or develops intraoperatively. There is often uncertainty regarding the exact location of the SIEV within the inferior incision of the DIEP flap. To our knowledge, no study has examined anatomical patterns of the vein at this level. This study was performed to determine the variability in location of the SIEV at the level of the inferior incision of the DIEP flap. We reviewed the preoperative CT angiograms of the last 50 sequential DIEP patients (100 hemiabdomens) to assess the distance of the SIEV from the midline at the level of the lower abdominal incision. The SIEV was absent or not clear radiologically at this level in one patient bilaterally and nine patients unilaterally. Of the 89 recorded measurements, the mean distance of the SIEV from the midline was 66 mm (range 50-83, SD 7). All measurements fell within 17 mm of the mean. We demonstrated that the position of the SIEV is consistent at the level of the inferior incision of a DIEP flap, and that this mean and range from the midline can be used to guide surgeons when attempting to identify this vessel.