2017 Volume 30 Issue 2 Pages 81-85
Free rectus abdominus myocutaneous ( RAMC ) flaps are generally nourished by the deep inferior epigastric artery ( DIEA ) and deep inferior epigastric vein ( DIEV ). There are few cases with anatomical anomalies regarding the DIEA and DIEV, and no reports refer to anomalous venal drainage of the RAMC flap or deep inferior epigastric perforator ( DIEP ) flap with DIEA and DIEV. Therefore, free RAMC and DIEP flaps are widely used to reconstruct tissue defects. DIEA and DIEV are anastomosed to recipient vessels as a matter of course.
We experienced an anomaly of venous drainage in a free RAMC flap. The flap we harvested had normal DIEA and DIEV; however, drainage via the DIEV was not observed. Main venous drainage was observed through a different path, which led to the intraperitoneum. This unusual drainage was adequate and the flap was completely viable post-surgery. Identifying the feeding and drainage vessels as soon as possible, as well as continuous observation of flap color to monitor for ischemia or congestive conditions is critical. If complications are seen, then the decision must be made to select some other vessel for anastomosis.
