ePlasty: Vol. 18
Utilizing the Retrograde Descending Internal Mammary Vein in DIEP Flap Anastomosis
Angie Zhang, BA,a Amra Kuc, BS,a Wilton Triggs, MD,b and Deniz Dayicioglu, MDb

aMorsani College of Medicine, University of South Florida, Tampa; and bDivision of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa

Correspondence: angiezhang@health.usf.edu
Keywords: venous congestion, chemotherapy catheter malposition, deep inferior epigastric perforator (DIEP) flap, breast reconstruction, additional venous drainage for DIEP flap


A 33-year old woman underwent a right mastectomy with bilateral deep inferior epigastric perforator (DIEP) flap reconstruction. Intraoperative discovery of a dislocated catheter prevented us from using the internal mammary vein (IMV) for anastomosis. With the aid of the venous congestion algorithm, we elected to anastomose the superficial inferior epigastric vein (SIEV) to the retrograde descending branch of the IMV stump.


1. Which vessels are used in DIEP anastomosis?

2. What is the proposed algorithm to address intraoperative venous congestion?

3. What considerations were made in selecting vessels for anastomosis in our patient?

4. What is the anatomy of chemotherapy catheter placeme .......