A MECHANICAL LEECH FOR TRANSVERSE RECTUS-ABDOMINIS MUSCULOCUTANEOUS FLAPS

Venous congestion in the intraoperative and postoperative period can b e a problem with some transverse rectus abdominis musculocutaneous fla ps. We evolved a technique to allow us the ability to bleed the conges ted flap in a controlled manner both intra- and postoperatively. Arter iotomy cannulae are placed within the lumens of the deep inferior epig astric artery (DIEA) and vein (DIEV) and they are brought out on the l ateral aspect of the reconstructed breast. We believe that intermitten t venous bleeding from the DIEV allows a congested flap time to improv e venous outflow and adapt to the new reversed blood circulation. When laser Doppler flow meter is simultaneously used as a monitor, bleedin g from the DIEV or DIEA can improve balance between arterial and venou s pressure in the flap.