Further validation for use of the retrograde limb of the internal mammary vein in deep inferior epigastric perforator flap breast reconstruction using laser-assisted indocyanine green angiography.

We have previously described the use of the retrograde limb of the internal mammary vein (IMV) as an additional venous outflow tract in deep inferior epigastric perforator (DIEP) flap reconstruction. In the current study, we use the Novadaq SPY ((R)) system, a novel intraoperative angiographic method, to further validate the use of the retrograde limb of the IMV. The Novadaq SPY ((R)) system laser source was used with indocyanine green angiography to evaluate the arterial, anterograde venous, and retrograde venous anastomoses of 15 patients undergoing DIEP flap breast reconstruction. The number of perforators used, patient age, exposure to radiation, coupler size, and incidence of intraoperative congestion were recorded. All flaps survived, and there were no cases of intraoperative congestion. The average time required to perform the additional retrograde anastomosis was 12 minutes. Flow of indocyanine green not only revealed patency of our anastomoses but it confirmed unobstructed flow through the retrograde limb of the IMV. Our study further validates that the retrograde limb of the IMV does in fact achieve flow away from the DIEP flap and can therefore be used as an additional or alternative outflow tract in DIEP flap breast reconstruction surgery.