The utility of elastic spacer hooks in internal mammary vessel preparation for diep anastomosis

The deep inferior epigastric perforator (DIEP) flap has become a standard method of autologous breast reconstruction. However, two teams are still needed to harvest this flap. A firt surgeon and his assistant harvest the DIEP flap while a second surgeon dissects the recipient vessels. The latter are essentially internal mammary vessels dissected with or without rib resection. The opening of the surgical field to expose the internal mammary vessels consists in reflecting the edges of the cutaneous-fat detachment along the 3rd or 4th costal cartilage. This can be done by an assistant. However, when the surgeon is alone to prepare the internal mammary vessels, he can use Beckmann auto-static spacers. This technique is nevertheless cumbersome and offers only a vertical opening to the operative field. The horizontal opening, from the medial edge perpendicular to the vessels is difficult. Elastic spacer hooks (Fig. 1) allow the surgeon preparing recipient vessels to work alone and with a minimal footprint. They also make it possible, if an assistant is present, to use his help more effectively, not simply for exposing with spacers, but for dissecting the recipient vessels or in performing anastomosis of the flap pedicle. Hyungsuk et al. already seem to use these spacers without citing them, as their pictures shown. The elastic spacers in question are Lone Star VR Elastic stays–Sharp hook 5 mm, traditionally used in proctological or gynecological surgery. The retractor-ring on which the elastic spacers are fixed in these indications is not used by our team as we feel it to be too cumbersome. Once hooked to the medial, superomedial, and inferomedial edges, elastic spacers are attached to the sterile drapes by simple clamps (Fig. 1). In our experience, on average of 5 spacers are required per procedure. A box of 8 spacers is priced at about 40 USD and thus has a low impact on the total cost of the surgery. Elastic spacer hooks allow the surgeon to enjoy greater comfort thanks to increased working space and a limited footprint. The additional cost generated can be justified