title: The use of retrograde limb of internal mammary vein in autologous breast reconstruction with DIEAP flap: anatomical and clinical study.
abstract: BACKGROUND
  It has been postulated that the abdominal skin may have either predominantly deep or superficial venous drainage. This may account for complications arising from autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEAP) flap. In this study, we evaluate the use of the retrograde limb of the internal mammary vein (IMV) as a second recipient vein in reconstructions with the DIEAP flap.
  
  
  METHODS
  In Part A, 10 IMVs were harvested from 5 fresh cadavers and the flow of methylene blue through the retrograde limb and the presence of valves were evaluated under a stereoscopic microscope.In Part B, the clinical outcomes of 38 patients who underwent single or bilateral autologous breast reconstruction using the DIEAP flap technique between January 2007 and March 2011 were reviewed. A total of 48 flaps were evaluated: 31 with single vein anastomosis and 17 with 2-vein anastomosis.
  
  
  RESULTS
  In Part A, no valves were identified in the IMVs. In all 10 cadaver IMVs, there was free flow of methylene blue in both antegrade (superior) and retrograde (inferior) directions.In Part B, a retrospective analysis of the 2 patient outcomes was performed. Outcomes assessed included total flap loss, partial flap necrosis, fat necrosis, wound infection, wound dehiscence, and hematoma. Results were compared using a 2-tailed Fisher exact test with a critical P value of 0.05. No statistically significant differences between groups were identified.
  
  
  CONCLUSIONS
  The retrograde limb of the IMV seems to be a safe alternate recipient vein in DIEAP and muscle sparing free TRAM autologous breast reconstruction. This study does not identify a significant reduction in overall fat necrosis or overall complications when using the 2 venous repair techniques versus the simple venous repair technique.
authors.affiliation: From the Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Dhamin
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Bissell
authors.forename: Vani
authors.initials: V
authors.lastname: Prasad
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001940:Breast / Q000098:blood supply*; D016022:Case-Control Studies; D019074:Epigastric Arteries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply* / Q000601:surgery*; D012039:Regional Blood Flow / Q000502:physiology; D014680:Veins / Q000473:pathology / Q000601:surgery