A case of intraoperative venous congestion of the entire DIEP-flap--a novel salvage technique and review of the literature.
The deep inferior epigastric perforator (DIEP) flap is gaining popularity for autologous breast reconstruction as it reportedly reduces abdominal donor site morbidity when compared with the transverse rectus abdominis musculocutaneous (TRAM) flap. Disadvantages include greater technical difficulties during flap harvest and a greater incidence of vascular compromise. A well-known and feared complication is venous congestion which requires immediate intervention. We present a novel salvage technique in a case of total flap venous congestion in the setting of absent drainage via the deep inferior epigastric vein (DIEV). Utilizing the superficial venous system via the superficial inferior epigastric vein (SIEV) and using the DIEV as a venous interposition graft resulted in successful salvage of the DIEP flap.
Momeni
Arash
A
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford University, Palo Alto, CA 94304-5715, USA. amomeni@stanford.edu
Lee
Gordon K
GK
D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D016462:Mammaplasty; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply*; D020858:Tissue and Organ Harvesting