DIEP free flap穿通枝損傷に対しIVaS ( Intravascular stenting ) 法を用いてサルベージを試みた2例

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  • Two Cases of Salvage Surgery for Flap Perforator Trouble of DIEP Free Flaps Using the IVaS Method

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Background : Deep inferior epigastric artery perforator ( DIEP ) free flap has become one of the good options for breast reconstruction due to its advantage of less donor site morbidity. We experienced a rare complication of intraoperative perforator avulsion and spasm and attempted to salvage this situation using the intravascular stenting ( IVaS ) method. <br>Case reports : A 64-year-old woman who underwent breast reconstruction using a DIEP free flap accidentally suffered perforator avulsion, and a 40-year-old woman had persistent perforator spasm due to a previously formed abdominal scar during flap harvesting procedures. In these two cases, the IVaS method was performed to salvage these situations. <br>Result : Although the salvage procedures using the IVaS method in these two cases were performed successfully, there was extensive flap loss in the former case and partial flap loss in the latter case. In the former case, progressive venous thrombosis occurred three days postoperatively, and in the latter case, repeated temporary flap ischemia occurred due to unstable blood flow of the salvaged perforators. <br>Discussion : The IVaS method is supposed to be a technically reliable technique to overcome perforator difficulties, but careful postoperative care is necessary for such patients due to the fragility and instability of the salvaged perforators.

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