Teven Chad M, Ooi Adrian S H, Chang David W, Song David H
Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2016 Dec 29;4(12):e1031. doi: 10.1097/GOX.0000000000001031. eCollection 2016 Dec.
Autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap has become increasingly popular because of its unique advantages. However, compared with some other forms of abdominal-based autologous reconstruction, DIEP flaps are associated with an increased risk of venous congestion. Many techniques-or lifeboats-have been introduced to diagnose and treat this potentially devastating complication. In this case report, we describe a novel strategy to augment venous drainage when venous congestion is encountered. A patient presented requesting autologous reconstruction and removal of a venous access catheter that had been used for chemotherapy administration. We performed left delayed breast reconstruction using a single-perforator DIEP flap from the right hemiabdomen. The superficial inferior epigastric vein to this flap was preserved. After removal of the Port-a-Cath from the left chest, we anastomosed the superficial inferior epigastric vein to the fibrous capsular sheath that had formed around the indwelling catheter to allow additional venous drainage. Flow through this conduit was confirmed using Doppler ultrasound. There were no flap-related complications, and the patient was discharged in good condition. Further research is warranted to characterize the indications and limitations of this novel lifeboat.
使用腹壁下深动脉穿支（DIEP）皮瓣进行自体乳房重建因其独特优势而越来越受欢迎。然而，与其他一些基于腹部的自体重建形式相比，DIEP皮瓣发生静脉充血的风险增加。人们已经引入了许多技术——或“救生艇”技术——来诊断和治疗这种可能具有毁灭性的并发症。在本病例报告中，我们描述了一种在遇到静脉充血时增加静脉引流的新策略。一名患者前来要求进行自体重建并移除用于化疗给药的静脉通路导管。我们使用来自右侧半腹部的单穿支DIEP皮瓣进行了左侧延迟乳房重建。保留了该皮瓣的腹壁浅静脉。在从左胸部取出植入式静脉输液港后，我们将腹壁浅静脉与围绕留置导管形成的纤维包膜鞘进行吻合，以实现额外的静脉引流。使用多普勒超声确认了通过该管道的血流。未出现与皮瓣相关的并发症，患者康复出院。有必要进一步研究以明确这种新型“救生艇”技术的适应症和局限性。
