Use of Composite Arterial and Venous Grafts in Microsurgical Breast Reconstruction: Technical Challenges and Lessons Learned

Summary: The success of microvascular reconstruction depends on many factors. While many factors can't be dictated by a surgeon, the success of anastomosis can be maximized by honing the anastomotic skill. However, size discrepancy of vessels still remains a common challenge given the lack of an ideal technique. In our study, we introduce our experience in using composite deep inferior epigastric (DIE) arterial and venous grafts to overcome the vessel size and pedicle length discrepancy in lateral thigh flap (LTP) and superficial inferior epigastric artery (SIEA) flaps, which can lead to higher flap failures secondary to vessel thrombosis and size discrepancy. Of the 1095 flaps performed, we identified a total of 12 flaps (1 LTP, 11 SIEA) on 9 patients for breast reconstruction. We used DIE-vessels to act as an interposition grafts between internal mammary (IMA) and flap pedicle. For the SIEA flaps, we anastomosed SIEA system to the DIEA system, checked viability of flap, and then transferred to the IMA system in 3 patients. In the last 5 patients, we anastomosed the DIE-vessels to the IMA system first, and then transferred the SIEA flap. For the LTP flap, we anastomosed grafts to IMA system first as well. There were no flap losses or fat necrosis. While our outcomes are only limited to breast reconstruction, we believe this method could be expanded to different types of reconstruction, especially head and neck. Financial Disclosure and Products: The authors have no financial interest to declare in relation to the content of this article Institutional review board statement: IRB has approved this study Corresponding Author Contact Information: Address correspondence to: Sumeet S. Teotia M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, TX 75390. Sumeet.Teotia@UTSouthwestern.edu ©2018American Society of Plastic Surgeons

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