Continuous intraarterial infusion of prostaglandin E1 and heparin to extend and improve the survival of pedicled musculocutaneous flaps through unusual routes: a clinical preliminary report.

Sixteen pedicled musculocutaneous flaps (pectoralis major, 3; latissimus dorsi, 4; and transverse rectus abdominis musculocutaneous [TRAM], 9) received continuous intraarterial infusion of prostaglandin E1 (5 micrograms/k of flap per day) and heparin (100 to 200 U/cannula per day) for 14 days postoperatively to extend the flap or improve survival in a high-risk patient. Therapy was successful in 15 patients. To preserve the main arterial inflow to the flap, the infusion was administered via the lateral thoracic artery in the pectoralis major and a branch to the serratus anterior muscle in latissimus dorsi flaps in retrograde fashion, respectively, and was via both the ipsilateral deep epigastric artery and the contralateral superficial epigastric artery in TRAM flaps. This technique permits the use of a pedicled flap in some patients who would otherwise require a free flap.