title: The effect of abdominal wall plication on intra-abdominal pressure and lower extremity venous flow: a case report.
abstract: Abdominal wall plication is known to cause increased intra-abdominal pressure (IAP). Whether plication-associated increased IAP causes lower extremity venous stasis, a recognized risk factor for DVT, remains unknown. A 55-year-old woman had a unilateral pedicled TRAM procedure for mastectomy reconstruction. Prior to plication, duplex ultrasound measured proximal femoral vein (PFV) cross-sectional diameter and volume-flow. PFV measurements were repeated immediately after plication and on post-operative days (POD) 1, 2, and 4. Bladder pressure was measured at similar timepoints. PFV volume-flow decreased from 0.22 L/min to 0.16 L/min (73% of baseline) immediately post-plication and reached a nadir of 0.08 L/min (36% of baseline) on POD 2. Bladder pressure increased from 13 mm Hg to 19 mm Hg after plication, and peaked at 31 mm Hg after intra-operative trunk flexion to 30°. Thus, abdominal wall plication was associated with increased intra-abdominal pressure and ultrasound-documented lower extremity venous stasis that persisted for 48 h after surgery.
authors.affiliation: Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA. cpannucc@umich.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pannucci
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Brown
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wakefield
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Wilkins
mesh_terms: D000005:Abdomen / Q000503:physiopathology* / Q000601:surgery; D034861:Abdominal Wall / Q000601:surgery*; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000150:complications* / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging; D016462:Mammaplasty / Q000009:adverse effects*; D008875:Middle Aged; D013524:Surgical Flaps / Q000009:adverse effects* / Q000098:blood supply; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology