title: Safety of salvaging impending flap congestion in breast reconstruction by venous supercharging of the cephalic vein.
abstract: Autologous flap breast reconstruction is an established technique that carries a risk of vascular failure. We evaluated the safety of salvaging impending venous congestion by using the cephalic vein for supercharging autologous abdominal flaps. Our main outcome measures were flap survival, triggering or impairing lymphedema as measured by the physician or reported by the patient, and scar severity as measured by the Vancouver scar scale. We were able to save 100% of the flaps, but could not find any statistical association with or without increased lymphedema before and after the procedure. One patient reported that lymphedema worsened. The patients accepted the scars (mean Vancouver scar scale score, 5.7). In sum, using the cephalic vein to improve venous drainage of autologous breast reconstruction was safe and did not trigger or impair lymphedema, but scarring in the upper arm was unavoidable.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery and †Biostatistics Section, Hospital Universitario La Paz; and ‡Division of Plastic and Reconstructive Surgery, Hospital Clínico Universitario, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Landin
authors.forename: Pedro
authors.initials: P
authors.lastname: Bolado
authors.forename: Cesar
authors.initials: C
authors.lastname: Casado-Sanchez
authors.forename: Jorge
authors.initials: J
authors.lastname: Bonastre
authors.forename: Marta
authors.initials: M
authors.lastname: Garcia-Redondo
authors.forename: Shirin
authors.initials: S
authors.lastname: Zharbakhsh
authors.forename: Jesus
authors.initials: J
authors.lastname: Diez
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Cesar
authors.initials: C
authors.lastname: Casado-Perez
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000601:surgery*; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply* / Q000601:surgery; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation