A mechanical leech for transverse rectus abdominis musculocutaneous flaps.

Venous congestion in the intraoperative and postoperative period can be a problem with some transverse rectus abdominis musculocutaneous flaps. We evolved a technique to allow us the ability to bleed the congested flap in a controlled manner both intra- and postoperatively. Arteriotomy cannulae are placed within the lumens of the deep inferior epigastric artery (DIEA) and vein (DIEV) and they are brought out on the lateral aspect of the reconstructed breast. We believe that intermittent venous bleeding from the DIEV allows a congested flap time to improve venous outflow and adapt to the new reversed blood circulation. When laser Doppler flow meter is simultaneously used as a monitor, bleeding from the DIEV or DIEA can improve balance between arterial and venous pressure in the flap.