遊離腹直筋皮弁移植時にうっ血をきたし深上腹壁静脈のSuper drainageを行った症例

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  • Super Drainage via the Superior Epigastric Vein to Treat Congested Rectus Abdominis Musculocutaneous Flap

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A 54-year-old man underwent surgical treatment for mesopharyngeal cancer. He had a history of prostate cancer and underwent laparoscopically assisted total prostatectomy via a lower abdominal midline incision. The mesopharyngeal cancer was treated by bilateral neck dissection and total glossectomy with preservation of the larynx. To maintain eating function, swallowing function and larynx preservation after total glossectomy, reconstruction was performed using a rectus abdominis musculocutaneous flap. While exposing the deep inferior epigastric artery and vein during elevation of the rectus abdominis musculocutaneous flap, a laparoscopic examination showed severe stenosis in part of the vein due to scarring. As a supplementary vessel, the superior epigastric vein was isolated and elevated together with the flap. After suturing the flap over the tissue defect, the deep inferior epigastric artery was anastomosed to the superior thyroid artery, and the deep inferior epigastric vein to the internal jugular vein. When the flap was reperfused, congestion was observed in the flap. By anastomosing the superior epigastric vein to the contralateral facial vein, congestion of the flap was markedly improved. When congestion is predicted in the rectus abdominis musculocutaneous flap, super drainage via the superior epigastric vein is a useful method to improve congestion.

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