Pedicle preservation technique for arterial and venous turbocharging of free DIEP and muscle-sparing TRAM flaps.

Autologous tissue transfer is a reliable method for breast reconstruction and is considered by many to be the optimal technique for postmastectomy breast reconstruction.1 The move from free transverse rectus abdominis musculocutaneous (TRAM) flaps to muscle-sparing and perforator free flaps is a significant advance associated with decreases in postoperative pain and donor-site morbidity.2 In patients whose flaps demonstrate intraoperative arterial insufficiency or venous congestion, microvascular augmentation using “turbocharging” or “supercharging” techniques has been described.3–9 In the automotive world, turbocharging is the use of the engine’s own exhaust for additional power. Similarly, surgical turbocharging describes vascular augmentation using a vascular source present within the flap territory either directly or by means of an interposed vein graft. Surgical supercharging describes vascular augmentation using distant, unrelated source vessels.10,11 Current microvascular turbocharging and supercharging techniques require harvest of a vein graft conduit or dissection of a secondary donor vessel site, and options for intraoperative free flap salvage that stay true to the goals of limiting donorand recipient-site morbidity are limited. We present a novel technique and case series of arterial, venous, and arterial/venous turbocharging of deep inferior epigastric perforator (DIEP) and muscle-sparing TRAM flaps using the non–perforator committed branch of the deep inferior epigastric artery and vein. The pedicle preservation technique described in this article is easily incorporated into standard methods of flap dissection and provides a “lifeboat” for these delicate flaps that is readily used when the need for improved arterial perfusion and venous drainage is suspected or becomes apparent.