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A novel technique for augmenting venous outflow in the superior gluteal artery perforator (SGAP) flap
Katherine H. Carruthers, M.D., M.S., Ergun Kocak M.D., M.S., Pankaj Tiwari M.D., Shunsuke Yoshida, M.D.
West Virginia University
2018-01-31
Presenter: Katherine Carruthers, MD
Affidavit:
The above referenced material represents original work of the resident.
Director Name: Aaron Mason, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose
In microvascular surgery, venous insufficiency is one of the most common causes of early flap exploration and compromise. While venous bypass procedures have been described for many flaps, no prior studies have reported a reliable technique for augmenting venous flow in the superior gluteal artery perforator (SGAP) flap. We herein describe a novel method for augmenting venous outflow in the SGAP flap in the setting of autologous breast reconstruction.
Methods
At the time of surgery, the SGAP flap was elevated based on a dominant perforator as determined by preoperative CT angiography. Additionally, a second more marginal perforator is identified, dissected, and preserved in the event that the flap should require augmentation of venous outflow.
Results
We report a case of a free SGAP flap breast reconstruction with intraoperative venous insufficiency that was salvaged when this additional vein was used to augment venous outflow. In this case, the dominant pedicle vein was anastomosed to the proximal internal mammary vein (IMV). Despite a clearly patent anastomosis, the flap developed venous congestion, prompting the anastomosis of the second vein to the distal IMV in a retrograde fashion. The flap demonstrated resolution of congestion and ultimately provided a successful breast reconstruction.
Conclusion
We have proposed a technique for augmentation of venous outflow in SGAP flaps through anastomosis of a second perforating vein. By using this method, one of the most devastating complications associated with microsurgical breast reconstruction can potentially be avoided, allowing the SGAP flap to more reliably be used for breast reconstruction.
