title: Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus.
abstract: Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer.
authors.affiliation: School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
authors.forename: Joseph W
authors.identifier: 0000-0002-4503-9967
authors.initials: JW
authors.lastname: Duncumb
authors.affiliation: Plastic & Reconstructive Surgery Department, Addenbrooke's University Hospital, Cambridge CB2 0QQ, UK.
authors.forename: Kana
authors.initials: K
authors.lastname: Miyagi
authors.affiliation: Cambridge Breast Unit, Addenbrooke's University Hospital, Cambridge CB2 0QQ, UK.
authors.forename: Parto
authors.initials: P
authors.lastname: Forouhi
authors.affiliation: Plastic & Reconstructive Surgery Department, Addenbrooke's University Hospital, Cambridge CB2 0QQ, UK; Cambridge Breast Unit, Addenbrooke's University Hospital, Cambridge CB2 0QQ, UK; Postgraduate Medical Institute, Faculty of Health Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.
authors.forename: Charles M
authors.identifier: 0000-0002-0070-0838
authors.initials: CM
authors.lastname: Malata