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.