Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Microsurgery. 2020 Jan;40(1):74-78. doi: 10.1002/micr.30423. Epub 2019 Jan 28.
Abdominal free flaps such as the muscle sparing transverse rectus abdominis myocutaneous (ms-TRAM) or deep inferior epigastric artery perforator (DIEP) flap represent the gold standard in autologous breast reconstruction. We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross-over bypass. A 54-year-old woman with a thrombosis of the left subclavian port-system in the medical history was elected for simultaneous bilateral breast reconstruction with ms-TRAM and DIEP flaps. Intraoperatively, a venous congestion of the DIEP flap, which was connected to the left cranial internal mammary vessels, appeared. In the absence of sufficient ipsilateral venous recipient vessels, we performed a salvage procedure requiring a 15 cm small saphenous vein graft and presternal subcutaneous tunneling. The flap vein was anastomosed end-to-end with the contralateral caudal internal mammary vein using a coupler system. The postoperative course was uneventful and both flaps survived. We describe the cross-over venous emergency bypass as a useful tool in unexpected venous thrombosis during bilateral free flap breast reconstruction.
腹部游离皮瓣，如肌保留横直肌腹皮瓣（ms-TRAM）或腹壁下动脉穿支皮瓣（DIEP），是自体乳房重建的金标准。我们描述了一例因静脉回流不足导致双侧游离皮瓣乳房重建失败而采用静脉交叉旁路进行挽救的病例。一名 54 岁女性，既往有左锁骨下腔静脉系统血栓形成史，拟行双侧 ms-TRAM 和 DIEP 皮瓣乳房重建术。术中，左侧颅内侧乳内血管吻合的 DIEP 皮瓣出现静脉淤血。由于同侧静脉受体血管不足，我们采用 15cm 小隐静脉移植物和胸骨前皮下隧道进行挽救性手术。皮瓣静脉与对侧尾侧内乳静脉端对端吻合，使用连接器系统。术后过程顺利，两个皮瓣均存活。我们描述了交叉静脉紧急旁路作为双侧游离皮瓣乳房重建中意外静脉血栓形成的一种有用工具。
