Tarakji Michael, Bartow Matthew J, Dupin Charles, Tessler Oren
Louisiana State University Health Science Center-New Orleans, New Orleans, La.
Plast Reconstr Surg Glob Open. 2017 Jun 23;5(6):e1367. doi: 10.1097/GOX.0000000000001367. eCollection 2017 Jun.
The most common recipient vessels for autologous free flap breast reconstruction are the internal mammary vessels. At times, there are problems with the exposed internal mammary vein (IMV) that require other options such as using the contralateral IMV, superior rib resection to access proximal IMV, retrograde IMV use, and thoracodorsal vein access with or without a vein graft. This case demonstrates using the pectoral branch of the thoracoacromial venous system without a vein graft as a lifeboat option when the IMV is not suitable for anastomosis. C.W. was a 65-year-old female who underwent right-sided mastectomy with placement of a tissue expander. After adjuvant radiation therapy, C.W. underwent deep inferior epigastric perforator free flap breast reconstruction. During exposure of the internal mammary artery and IMV, an iatrogenic venotomy occurred that precluded the use of this vessel as a reliable recipient. The deep inferior epigastric perforator flap pedicle was then dissected proximal to isolate the artery and vein, and the vein was successfully anastomosed to the venous pectoral branch of the thoracoacromial system. The postoperative course was uneventful and patient was discharged home on postoperative day 4. Using the venous pectoral branch of the thoracoacromial is a safe and valuable option that can be considered in difficult situations when the IMV is not a suitable option.
自体游离皮瓣乳房重建最常用的受区血管是胸廓内血管。有时，暴露的胸廓内静脉（IMV）会出现问题，这就需要其他选择，比如使用对侧IMV、切除上位肋骨以显露近端IMV、逆行使用IMV，以及使用或不使用静脉移植的胸背静脉入路。本病例展示了在IMV不适合吻合时，将胸肩峰静脉系统的胸肌支作为一种挽救方案，不进行静脉移植。C.W.是一名65岁女性，接受了右侧乳房切除术并植入了组织扩张器。辅助放疗后，C.W.接受了腹壁下深动脉穿支游离皮瓣乳房重建。在暴露胸廓内动脉和IMV时，发生了医源性静脉切开，导致无法将该血管用作可靠的受区血管。然后在近端解剖腹壁下深动脉穿支皮瓣蒂部以分离动脉和静脉，并成功将静脉与胸肩峰系统的胸肌静脉支进行了吻合。术后过程顺利，患者于术后第4天出院。当IMV不是合适选择时，在困难情况下，使用胸肩峰静脉的胸肌支是一种安全且有价值的选择。
