Internal mammary artery and vein supercharge in tram flap breast reconstruction

Abstract

To improve the blood supply of the pedicled flap we have performed an additional microvascular augmentation to this type of breast reconstruction procedure since 1991. The ipsilateral deep inferior epigastric pedicle is anastomosed to the internal mammary artery and vein (IMAV supercharge). In 19 of 20 patients this technique proved to be feasible. For the venous anastomoses the 3M microvascular anastomosis system facilitated the procedure. In one patient the venous anastomosis failed due to the small calibre of two internal mammary veins. In a majority of the cases rapid improvement of flap perfusion could be observed as the direct result of the supercharging. The IMAV supercharged flap is quite comparable with the free flap as regards to the operative procedure. Disadvantages are a slightly more extensive dissection and less freedom in positioning the flap due to the presence of the superior muscular pedicle. The main advantage is that the supercharge procedure minimises the risk of total flap loss. Further technical improvement may be obtained by the use of a contralateral vascular pedicle dissected with muscle-sparing techniques.

A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: Investigating the effect on venous congestion and flap survival

“…In a move to minimize venous complications, the use of secondary alternate pathways in addition to the deep inferior epigastric vein (DIEV) for venous drainage has been described, albeit usually performed after venous congestion has already occurred. These options, described for augmenting or supercharging the venous drainage of congested flaps, have been broad, with the methods used comprising additional venae comitantes of the ipsilateral DIEA, 4,5 venae comitantes of the contralateral DIEA, 6 the ipsilateral superficial inferior epigastric vein (SIEV), 2,3,7 and the contralateral SIEV. 8 These reports have all comprised case reports or series of relatively low numbers, and given the low incidence of venous congestion, this has limited the formal evaluation of contributory factors for venous congestion.…”

Changes in arterial blood flow of free flaps after the administration of sildenafil in swine

“…The above findings provide further rationale for a possible “local” beneficial hemodynamic effect on the free flap, after the administration of sildenafil, which is not related to pertinent alterations in systemic hemodynamics 12–14, 33. This acute hemodynamic effect of sildenafil on the free flap may enhance the occurrence of additional microvascular augmentation that could be normally observed after microsurgical interventions (e.g., supercharging) 39–42. This might have beneficial effect in bulky or large flaps that require delay phenomenon or supercharging to ensure viability, and in functioning free muscle flaps where reperfusion may be a crucial factor 39–42.…”

Inclusion of Tissue Beyond a Midline Scar in the Deep Inferior Epigastric Perforator Flap

“…5-7 • The "supercharged" TRAM is a unipedicled flap with microvascular anastomosis of the deep inferior epigastric artery/vein (DIEA/V ͓or SIEA/V͔) to recipients in the chest. 8,9 Although this strategy is well-established, we find that combining pedicle and free techniques mitigates the advantages of either, while compounding the disadvantages of both. • The "turbocharged" TRAM (also described as the "recharged" or "parasite" TRAM) is similar to the supercharged TRAM, but with anastomosis of the opposite DIEA/V to the distal end of the ipsilateral DIEA/V, so that the opposite side of the flap is supplied by retrograde runoff from the pedicled side.…”