An anatomic study of the venous drainage of the transverse rectus abdominis musculocutaneous flap.

The authors studied the venous drainage of the abdominal wall and its application to the transverse rectus abdominis musculocutaneous flap on 12 cadavers by injecting methylene blue and methyl methacrylate to follow the venous pathways. The nonvascular tissues of the specimens injected with methyl methacrylate were corroded away to show the three-dimensional arrangement of the vessels. We describe the veins of the anterior abdominal wall in relation to the transverse rectus abdominis musculocutaneous flap. The venous drainage of the transverse rectus abdominis musculocutaneous flap when used for breast reconstruction occurs from the cutaneous part of the flap to the inferior deep epigastric veins through vertical perforators that are mainly periumbilical. From there the flow is through the deep superior epigastric veins into the internal mammary vein. The deep inferior epigastric veins were found to have valves that prevent retrograde flow. In designing the flap, its safety is increased if it includes the periumbilical perforators. Thinning the flap should be done at the deep surface to preserve Scarpa's fascia and the superficial epigastric system.