Internal mammary perforator vessels as recipient for microvascular breast reconstruction: Technique and outcomes in 161 flaps.

BACKGROUND: The use of internal mammary perforator (IMP) vessels as recipients for free flap breast reconstruction was first described in 1999. Despite numerous advantages over the internal mammary (IM) and thoracodorsal recipient vessels, their widespread use remains mired in concern. This paper describes our method of IMP vessel preparation and outcomes with regard to safety and reliability. METHODS: To support the reliability of the IMP vessel preparation, a retrospective study on prospectively collected data of all free flap breast reconstruction patients between 1 July 2016 and 31 July 2019 was performed. Data were collected on patient demographics, type of reconstruction operative details and complications. RESULTS: Out of the 450 flaps performed, the IMP vessels were used in 36% of the cases. Of these cases, 18% had received neo-adjuvant chemotherapy and 15% had a history of radiotherapy to the chest wall. In total, 161 flaps were performed to reconstruct 138 breasts (115 single and 23 stacked flaps). Three patients required a return to theatre, with one needing recipient vessel revision from the IMP to the IM vessels due to calibre mismatch. No mastectomy skin flap necrosis, free flap loss or significant fat necrosis were encountered. CONCLUSION: This article describes an IM vessel preparation method that results in predictable outcomes in both single and stacked flap reconstructions with a low complication rate. Due to their reliability and versatility, we consider the IMP vessels a valuable attribute to the recipient vessel arsenal of any breast reconstruction microsurgeon.

Atraumatic gluteal compartment syndrome-an unusual presentation of a rare syndrome.

ABSTRACT: Atraumatic gluteal compartment syndrome is a limb- and potentially life-threatening emergency. It is rare, with few reported cases, and can be difficult to diagnosis; a high index of suspicion is required for prompt diagnosis and management. This paper presents the case of a 36-year-old female who was brought into the emergency department following a prolonged period of unconsciousness. She had a delayed diagnosis of gluteal compartment syndrome associated with sciatic nerve palsy and underwent surgical decompression. Following surgery, the patient's symptoms resolved completely. This case highlights that in cases of delayed diagnosis, surgical decompression can still address patient morbidity and improve outcomes.