Case report. The use of both antegrade and retrograde internal mammary vessels in a folded, stacked deep inferior epigastric artery perforator flap.
OBJECTIVE
Deep inferior epigastric artery perforator (DIEP) flap is an excellent option for breast reconstruction in young and active patients who have a history of chest wall radiation. One drawback, however, is that the entire capacity of abdominal pannus cannot be reliably transferred on a single pedicle. The purpose of this case report is to demonstrate a method of maximizing the volume of reconstruction with a dual-pedicled DIEP flap.


METHODS
A case is reported in which both antegrade and retrograde internal mammary vessels were used as recipient sites for a dual-pedicled, folded, stacked DIEP flap.


RESULTS
Good flows were observed in both sets of recipient vessels intraoperatively. Postoperative imaging revealed patent vascular anastomoses of both pedicles. At 1-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved.


CONCLUSIONS
To maximize the volume of the reconstructed breast, the entire abdominal pannus can be utilized. The retrograde limb of internal mammary vessels can act as the recipient site for the second pedicle, minimizing donor site morbidity.
Chan
Rodney K
RK
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02445, USA.
Przylecki
Wojitec
W
Guo
Lifei
L
Caterson
Stephanie A
SA
J Plast Reconstr Aesthet Surg. 2009 Oct;62(10):1286-92
18675608
Ann Plast Surg. 2007 Apr;58(4):359-63
17413875
Plast Reconstr Surg. 2009 Sep;124(3):717-721
19730291
Br J Plast Surg. 1998 Oct;51(7):535-7
9924407
Ann Plast Surg. 1991 Sep;27(3):284-7
1835338
Ann Plast Surg. 1994 Jun;32(6):565-71
8074363
J Reconstr Microsurg. 2007 Nov;23(8):523-5
18189212
Br J Plast Surg. 2002 Jun;55(4):351-3
12160543
Aust N Z J Surg. 1979 Oct;49(5):527-30
159684
Plast Reconstr Surg. 1977 Feb;59(2):185-90
319465