Radial Artery And Cephalic Vein Interposition Graft To Salvage A DIEP Flap And Prevent No-Flow Phenomenon: A Case Report And Literature Review.

Abstract

Autologous tissue from the lower abdomen represents the optimal method for delayed breast reconstruction in the previously irradiated chest, as these flaps are capable of reproducing a reconstructed breast that approximates the shape, volume, softness and ptosis of the native breast.1 Unfortunately, delayed breast reconstruction in the setting of previous postmastectomy radiotherapy has been shown to have a higher complication rate2,3 due the soft-tissue sequelae caused by radiation including tissue fibrosis, edema and vasculitis which can interfere with healing of the reconstructed breast and can injure the internal mammary vessels increasing the risk of intraoperative and postoperative microvascular anastomotic complications.We present the relevant literature review and a case where a deep inferior epigastric perforator (DIEP) flap was not only salvaged with a radial artery vascular pedicle conduit graft, but fat cell damage was minimized by prompt revascularisation of flap to the arm. 1 Baumann DP, Lin HY, Chevray PM. Perforator number predicts fat necrosis in a prospective analysis of breast reconstruction with free TRAM, DIEP and SIEA flaps. Plast Reconstr Surg. 2010;125:1335-1341. 2 Tran NV, Chang DW, Gupta A, Kroll SS, Robb GL. Comparison of immediate and delayed TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg. 2001;108:78-82. 3 Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: Current issues. Plast Reconstr Surg. 2004; 114:950-960.