Benefits of superdrainage using SIEV in DIEP flap breast reconstruction: A systematic review and meta-analysis

Background: Superdrainage using superficial inferior epigastric vein (SIEV) has been often used to overcome occasional venous insufficiency in deep inferior epigastric perforator (DIEP) flap. However, a consensus regarding its clinical benefits is lacking. The aim of this review was to evaluate the efficacy of superdrainage using SIEV on clinical outcome in DIEP flap breast reconstruction by meta-analytic methodology. Methods: Medline, Ovid and Google Scholar were searched to obtain all relevant publications. Pooled risks for perfusion-related complications were compared between the superdrainage group and control group by Mantel–Haenszel test. Results: Six studies representing 1,376 cases (842 superdrainage and 534 control group) were enrolled, all of which were retrospective cohort studies. Superdrainage had little influence on the risk of total flap loss (RR: 0.97, 95% CI: 0.36–2.57). There were trends toward decreasing risks of partial flap loss (RR: 0.59, 95% CI; 0.18–1.94) and fat necrosis (RR: 0.87, 95% CI: 0.58–1.30) in the superdrainage group, though they were not significant. The risk of partial flap necrosis in which partial flap loss and fat necrosis were combined, was reduced 20% in the superdrainage group, although statistical significance was not achieved (RR: 0.80, 95% CI: 0.57–1.11). The risk of flap congestion decreased significantly in the superdrainage group (RR: 0.06, 95% CI: 0.01–0.51). Conclusions: Although there is obvious benefit of SIEV superdrainage in reducing the risk of flap congestion, evidence supporting its use to prevent flap compromise is still insufficient. Further studies would be required.