Portal de Periódicos da CAPES

Short reports and correspondence

1999; Elsevier BV; Volume: 52; Issue: 7 Linguagem: Inglês

10.1054/bjps.1999.3210

1465-3087

Angelica Kavouni, Mohammed Shibu,

Problems associated with the use of internal mammary vessels as recipients for free flap breast reconstruction Sir, We enjoyed reading the paper by Majumder and Batchelor (Br J Plast Surg 1999; 52: 286-9) concerning the incidence of complications specific to the use of the internal mammary vessels (IMVs) as a recipient site for free flap breast reconstruction.We agree with the authors that careful dissection of the IMVs reduces morbidity to a minimum.However, in very thin patients, the contour defect subsequent to costal cartilage excision can be significant.This may not be obvious on the operating table, after careful contouring at the time of flap inset but may become apparent a few months postoperatively, when the reconstructed breast develops a degree of ptosis.Out of 19 cases of free TRAM breast reconstruction using the IMVs as recipient site, one of the patients developed a very significant contour defect at the medial side of the breast, necessitating correction (Fig. 1).We would also like to draw attention to a second point.Although the IMVs are a reliable system for anastomosing the inferior epigastric vessels, the vein can often be of very small calibre (<1.5 mm) rendering the anastomosis difficult.Furthermore, the level at which the venae comitantes join to form a single trunk varies considerably.The use of colour Doppler ultrasound, which locates the vessels with the largest diameter, helps to select the appropriate rib for dissection.