title: [Strategies in case of unusable internal mammary vessels in a mammary reconstruction by DIEP].
abstract: BACKGROUND
  We analyzed the strategy of microvascular connection during the DIEP in case of unusable internal mammary vessels in intraoperative period.
  
  
  METHODS
  It is about five cases of mammary reconstructions by DIEP practiced in a plastic surgery department. We modified our connections because the quality of the artery and/or the vein was considered insufficient.
  
  
  RESULTS
  In case of internal mammary artery unusable, we changed the donor site and the flap was anastomosed with circumflexe scapular vessels. In case of internal mammary vein judged unusable but with usable artery, we anastomosed the DIEP with the internal mammary artery and with the cephalic vein. We added a venous substitution by the second connection with the deep inferior epigastric venous by coupler's technique.
  
  
  CONCLUSIONS
  Circumflexe scapular artery was the first alternative of internal mammary artery. In every case we protected the thoracodorsal pedicle.
authors.affiliation: Service de chirurgie plastique, hôpital René-Dubos, 6, avenue de l'île-de-France, 95300 Pontoise, France. dreleonorecohen@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Cohen-Hayoun
authors.forename: R
authors.initials: R
authors.lastname: Pessis
authors.forename: C
authors.initials: C
authors.lastname: Lkah
authors.forename: M
authors.initials: M
authors.lastname: Atlan
mesh_terms: D000465:Algorithms; D000714:Anastomosis, Surgical / Q000379:methods*; D001158:Arteries / Q000601:surgery; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008408:Mastectomy; D008866:Microsurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012540:Scapula / Q000098:blood supply*; D014680:Veins / Q000601:surgery