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Management of abnormal deep inferior epigastric vessels in microsurgical breast reconstruction: a report of 3 complex cases

  • Georgios Orfaniotis
  • Toby Ivor Vinycomb
  • Simon Overstall
  • Eldon Mah
  • Vachara Niumsawatt
  • Dean Trotter
Case Report

Abstract

The deep inferior epigastric artery perforator flap is the gold standard in microsurgical breast reconstruction. It is now increasingly offered in patients with previous abdominal scars and in such cases, computed tomography angiography (CTA) is routinely implemented. However, previous injury of the deep inferior epigastric vessels may be difficult to detect with CTA. We report three cases of successful bilateral breast reconstruction, in which a unilateral DIEA was found to be abnormal. In the first two cases, the unilateral DIE vessels were found to be damaged and the flaps salvaged based on the deep superior epigastric artery. In the third patient, previous DIEA injury resulted in vessel recanalization, which was only evident following initial anastomotic failure. In this case, the damaged DIEA segment was subsequently removed and the flap successfully revascularized. All three patients had an uneventful post-operative recovery and all flaps survived with no complications. Based on our experience, we believe that awareness of the potential pitfalls and careful planning for lifeboats are essential to avoid flap loss in such circumstances.

Level of Evidence: Level V, therapeutic study.

Keywords

Microsurgery DIEP flaps Computed tomography angiography Epigastric vessels Abdominal scars 

Notes

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Patient consent

Informed written consent was obtained from all participants whose potentially identifying photographs have been used in this manuscript.

Conflict of interest

Georgios Orfaniotis, Toby Vinycomb, Simon Overstall, Eldon Mah, Vachara Niumsawatt, and Dean Trotter declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Georgios Orfaniotis
    • 1
  • Toby Ivor Vinycomb
    • 1
  • Simon Overstall
    • 1
  • Eldon Mah
    • 1
  • Vachara Niumsawatt
    • 1
  • Dean Trotter
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryRoyal Melbourne HospitalParkvilleAustralia

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