Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Hydrogen Peroxide Priming Of Cadaveric Veins Reveals The Underlying Anatomical Basis For Venous Complications Of DIEP, TRAM And Other Flaps Of The Anterior Torso
Kwok Hao Lie, MA MB BChir, G. Ian Taylor, AO MD FRACS FACS, Mark W. Ashton, MD FRACS.
University of Melbourne, Parkville, Melbourne, Australia.

Introduction and Purpose
Previous studies of venous anatomy lack the detail of their arterial counterparts due to (i) the technical challenge of retrograde perfusion against competent valves and (ii) anterograde venous perfusion that fails to capture significant portions of the area of interest. A novel technique is presented that uses retrograde hydrogen peroxide priming in order to dilate veins and render valves incompetent, thereby facilitating full cadaveric venous perfusion.
Materials and Methods
The superficial and deep venous systems of 41 hemiabdomens and 20 hemi-chests of fresh human cadavers were cannulated and primed by retrograde injection with 6% hydrogen peroxide. After 24 hours, the specimens were injected with lead oxide contrast, radiographed and dissected. In 3 hemiabdomens, the veins were dissected to map valve sites and orientation.
Results were compared with our archival venous studies of 6 total body injections, 6 abdominal lipectomy specimens and 2 in vivo studies of patients undergoing delayed TRAM flap operations.
Results
Studies demonstrated venous filling with unprecedented detail of the anterior abdomen and chest wall. Two types of superficial-to-deep venous connections were defined - large caliber venae communicantes and small caliber venae comitantes. Venae communicantes (>2mm) formed major connections between large superficial and deep veins. They were found most frequently within 5cm of the umbilicus in the abdomen and beside the sternum, the fifth or sixth intercostal space and the axilla in the chest. Such veins typically accompany large arterial perforators, although in 26% of studies they were found with arteries <0.5mm in diameter.
Four major longitudinal valved subcutaneous pathways of the SIEV and SCIV were defined bilaterally in the abdomen with large caliber avalvular transverse supraumbilical, subumbilical and suprapubic connections in the midline and small caliber connections laterally that help explain venous complications seen sometimes in DIEP and other abdominal flaps.
Conclusions
Retrograde hydrogen peroxide priming of veins in unembalmed cadavers renders valves incompetent and facilitates highly detailed venous injection studies. This information explains the aetiology of zone IV, hemiabdominal and diffuse venous congestion in transverse abdominal flaps, and also helps inform and refine flap design.







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