A simple way for salvage of zone IV deep inferior epigastric perforator flap using pre-tie sutures and serial delayed closure

摘要

The free deep inferior epigastric artery perforator flap (DIEP) was first described by Koshima and Soeda in 1989.1 This flap provides a large amount of skin and soft tissues for reconstructive purposes with a minimal donor site morbidity and a resulting scar similar to an addominoplasty procedure.When the flap is harvested, both superficial epigastic veins are interrupted and all the venous drainage is redistributed into the deep system by the venae comitantes accompanying the perforator.Venous complications could be due to venae comitantes too small or injured during the surgical dissection.2 Furthermore venous congestion often involv.es zone IV, the part of the flap farthest across the midline from the perforators. Consequently zone IV is considered unreliable and is frequently discarded.We present this case to report an easy way for the salvage of zone IV demonstrating that inclusion of zone IV may be reliable, even if only a single perforator is incorporated into the flap.