Proposition d’un algorithme en cas de vaisseaux mammaires internes inutilisables lors d’une reconstruction mammaire par DIEP

Abstract

We analyzed the strategy of microvascular connection during the DIEP in case of unusable internal mammary vessels in intraoperative period. It is about five cases of mammary reconstructions by DIEP practiced in a plastic surgery department. We modified our connections because the quality of the artery and/or the vein was considered insufficient. In case of internal mammary artery unusable, we changed the donor site and the flap was anastomosed with circumflexe scapular vessels. In case of internal mammary vein judged unusable but with usable artery, we anastomosed the DIEP with the internal mammary artery and with the cephalic vein. We added a venous substitution by the second connection with the deep inferior epigastric venous by coupler's technique. Circumflexe scapular artery was the first alternative of internal mammary artery. In every case we protected the thoracodorsal pedicle.