Use of Composite Arterial and Venous Grafts in Microsurgical Breast Reconstruction: Technical Challenges and Pitfalls
Min-Jeong Cho, M.D., Austin Hembd, M.D., Christopher Venutolo, B.S., Sumeet S. Teotia, M.D., Nicholas T. Haddock, M.D..
University of Texas Southwestern Medical Center, Dallas, TX, USA.
The success of microvascular reconstruction depends on many factors. While many factors canít be dictated by a surgeon, the success of anastomosis can be maximized by honing the anastomotic skill. However, size discrepancy of vessels still remains as a common challenge given the lack of an ideal technique. In our study, we used composite deep inferior epigastric(DIE) arterial and venous grafts to overcome the size discrepancy in lateral thigh flap(LTP) and superficial inferior epigastric artery (SIEA) flaps, which are notorious for high flap failure due to size discrepancy.
We performed a total of 12 flaps(1 LTP, 11 SIEA) on 9 patients for breast reconstruction. We used DIE-vessels to act as an intermediary system between the internal mammary (IMA) and small perforator systems.
Total of 12 such composite grafts were used in 9 patients with 11 SIEA flaps and 1 LTP flap. Average dilated SIEA diameter was 1 mm, with average IMA 2.5 mm. Average SIEV was 2 mm and IMV 3 mm. In the first 3 patients, we anastomosed SIEA system to the DIEA system, checked the viability of flap, and then transferred to the IMA system. In the last 5 patients, we anastomosed the DIEA/V graft to the IMA system first, and then transferred the flaps. There were no flap losses or fat necrosis.
While our outcomes are only limited to breast reconstruction, we believe this method can be expanded to different types of reconstruction, especially head and neck where the most size discrepancy occur.
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