PMC5811277_01
PMC5811277_02
Case 2:Pedicle revision with reversed DIEA grafts (IMA to SIEA and IMV to SIEV).
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F1
The patient was discharged home on postoperative day 3 but returned on postoperative day 5 after noting right flap discoloration that started the previous night (see figure, Supplemental Digital Content 1, which displays a delayed presentation on postoperative day 5 with signs of flap ischemia, http://links.lww.com/PRSGO/A595). Both arterial and venous anastomoses were revised using DIEA grafts, 6 cm in length (Fig. 1), hand-sewn with 9-0 nylon suture.
Case 3:Appearance of pedicle upon exploration with significant arterial spasm and patent venous anastomosis.
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F2
Upon exploration, arterial Doppler signal was present on the IMA perforator and immediately distal to the anastomosis, but no signal was present as the SIEA entered the flap, consistent with spasm and insufficient inflow (Fig. 2).
Case 3:Pedicle revision with reversed DIEA graft interposed between IMA and SIEA.
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F3
The SIEA/IMA perforator anastomosis was divided, and the distal end of the DIEA graft was anastomosed to the SIEA, restoring flow (Fig. 3).
PMC5811277_03
Case 3:Appearance of pedicle upon exploration with significant arterial spasm and patent venous anastomosis.
gox-6-e1528-g002.jpg
PMC5811277_03_gox-6-e1528-g002.jpg
F2
Upon exploration, arterial Doppler signal was present on the IMA perforator and immediately distal to the anastomosis, but no signal was present as the SIEA entered the flap, consistent with spasm and insufficient inflow (Fig. 2).
Case 3:Pedicle revision with reversed DIEA graft interposed between IMA and SIEA.
gox-6-e1528-g003.jpg
PMC5811277_03_gox-6-e1528-g003.jpg
F3
The SIEA/IMA perforator anastomosis was divided, and the distal end of the DIEA graft was anastomosed to the SIEA, restoring flow (Fig. 3).
Case 3:Flap appearance at 4-month follow-up.
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F4
No fat necrosis of the right flap has been noted at 4-month follow-up (Fig. 4).