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DOI: 10.4103/0970-0358.146657
Salvage of a TRAM breast reconstruction flap using the retrograde internal mammary artery system
Publication History
Publication Date:
26 August 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042863/201403/lookinside/thumbnails/10-4103-0970-0358-146657_00447-1.jpg)
ABSTRACT
Background: Free tissue transfer provides an optimal means for breast reconstruction in creating an aesthetically natural appearance that is durable over time. The choice of donor vessels vary from surgeon to surgeon, but the internal mammary axis is one of the most popular choices together with the thoracodorsal vessels. Aims and Results: We present the case of a salvaged free transverse rectus abdominis myocutaneous breast reconstruction in which end-to-end antegrade anastomosis to the internal mammary artery (IMA) was not possible due to frail vessel walls, but retrograde anastomosis to the IMA and antegrade anastomosis of internal mammary vessel resulted in a perfused and viable flap. Conclusion: We suggest the use of the retrograde internal mammary arterial system for microsurgical anastomosis when the anterograde flow is not adequate, the vessel wall is friable, and when other more common options are not available.
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REFERENCES
- 1 Chun JK, Harmaty M, Ting J. Thoracoacromial vessels as the recipients for supercharged muscle-sparing transverse rectus abdominis myocutaneous flaps. J Reconstr Microsurg 2007; 23: 125-9
- 2 Caulfield RH, Maleki-Tabrizi A, Mathur B, Ramakrishnan V. Salvage of a DIEP flap using a retrograde flow anastomosis. J Plast Reconstr Aesthet Surg 2008; 61: 346-7
- 3 Liu TS, Ashjian P, Festekjian J. Salvage of congested deep inferior epigastric perforator flap with a reverse flow venous anastomosis. Ann Plast Surg 2007; 59: 214-7
- 4 Chan RK, Przylecki W, Guo L, Caterson SA. Case report. The use of both antegrade and retrograde internal mammary vessels in a folded, stacked deep inferior epigastric artery perforator flap. Eplasty 2010; 10: e32
- 5 Agarwal JP, Gottlieb LJ. Double pedicle deep inferior epigastric perforator/muscle-sparing TRAM flaps for unilateral breast reconstruction. Ann Plast Surg 2007; 58: 359-63
- 6 Mohebali J, Gottlieb LJ, Agarwal JP. Further validation for use of the retrograde limb of the internal mammary vein in deep inferior epigastric perforator flap breast reconstruction using laser-assisted indocyanine green angiography. J Reconstr Microsurg 2010; 26: 131-5
- 7 Mackey SP, Ramsey KW. Exploring the myth of the valveless internal mammary vein - A cadaveric study. J Plast Reconstr Aesthet Surg 2011; 64: 1174-9
- 8 Venturi ML, Poh MM, Chevray PM, Hanasono MM. Comparison of flow rates in the antegrade and retrograde internal mammary vein for free flap breast reconstruction. Microsurgery 2011; 31: 596-602
- 9 González-Santos JM, Bastida E, Riesgo M, Vallejo JL, Albertos JV, Fortuny R. et al. Flow capacity of the human retrograde internal mammary artery: Surgical considerations. Ann Thorac Surg 1990; 50: 360-6
- 10 Li S, Mu L, Li Y, Xu J, Yang M, Zhao Z. et al. Breast reconstruction with the free bipedicled inferior TRAM flap by anastomosis to the proximal and distal ends of the internal mammary vessels. J Reconstr Microsurg 2002; 18: 161-8