Studying the blood pressures of antegrade and retrograde internal mammary vessels: Do they really work as recipient vessels?

Publication date: Available online 22 May 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Yoko Katsuragi Tomioka, Hirokazu Uda, Kotaro Yoshimura, Ataru Sunaga, Hideaki Kamochi, Yasushi Sugawara
BackgroundThe proximal ends of the internal mammary (IM) vessels are now the most common recipient vessels for breast reconstruction. On the other hand, bilateral deep inferior epigastric artery perforator (DIEP) flaps are often needed according to the territory and the volume needed for reconstruction. The usefulness of retrograde IM vessels as second recipients has recently been reported, but there are very few quantitative studies on the hydrodynamics of the retrograde IM vessels. Since the flow is dependent on the pressure differential, the blood pressures of the antegrade IM artery (AIMA), antegrade IM vein (AIMV), retrograde IM artery (RIMA), retrograde IM vein (RIMV), and the recirculated intraflap vein (FV) were investigated to solve this question and confirm the reliability and usefulness of retrograde IM vessels.MethodsTen free flap breast reconstructions were included in this study. The IM vessels were exposed, and the pressures were measured. After recirculation, the FV pressures were measured when the flap was not ischemic or congestive. Systemic blood pressure was also recorded during the whole measurement period.ResultsThe AIMA pressure and RIMA pressure were 70.4 ± 8.2 mmHg and 54.0 ± 8.6 mmHg (p=0.000003), respectively, while the systemic pressure was 65.1 ± 10.0 mmHg. The AIMV pressure was always smaller than the RIMV pressure; the mean AIMV pressure was 5.3 ± 1.6 mmHg. In addition, the FV pressure was greater (p=0.03) than the RIMV pressure (17.7 ± 9.9 mmHg), while the RIMV was 8.7 ± 2.0 mmHg.ConclusionsBoth RIMA and RIMV are useful and reliable as second recipients for bipedicled free flap transfers. This is a great benefit because it would provide two recipients in one surgical site and would be especially useful in thin patients or patients with previous abdominal scars requiring double pedicled DIEP flaps.Level of EvidenceTherapeutic Study, Level IV.



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