Paradoxical Venous Doppler Signal: A Sentinel Sign of Early Venous Congestion

ABSTRACT

We present a case of early venous congestion in a superior gluteal artery perforator flap for breast reconstruction. The case is unique because the early detection was based on a paradoxical handheld Doppler signal. During reexploration, the vessels were compressed with intermittent obstruction on inspiration. The vessels were repositioned and the flap was salvaged with no further complications. The pathophysiology of this paradoxical sentinel sign is discussed, along with other reasons leading to the outflow obstruction.

KEYWORDS

Microsurgery - reconstructive breast surgery - superior gluteal artery perforator flap - venous congestion

REFERENCES

• 1 Hidalgo D A, Jones C S. The role of emergent exploration in free-tissue transfer: a review of 150 consecutive cases.  Plast Reconstr Surg. 1990;  86 492-498
• 2 Bar-Meir E D, Yueh J H, Tobias A M, Lee B T. Autologous fat grafting: a technique for stabilization of the microvascular pedicle in DIEP flap reconstruction.  Microsurgery. , In press
• 3 Bui D T, Cordeiro P G, Hu Q Y, Disa J J, Pusic A, Mehrara B J. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps.  Plast Reconstr Surg. 2007;  119 2092-2100
• 4 Tran N V, Buchel E W, Convery P A. Microvascular complications of DIEP flaps.  Plast Reconstr Surg. 2007;  119 1397-1405
• 5 Furnas H, Rosen J M. Monitoring in microvascular surgery.  Ann Plast Surg. 1991;  26 265-272
• 6 Russell J A, Conforti M L, Connor N P, Hartig G K. Cutaneous tissue flap viability following partial venous obstruction.  Plast Reconstr Surg. 2006;  117 2259-2266
• 7 Chen K T, Mardini S, Chuang D C et al.. Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers.  Plast Reconstr Surg. 2007;  120 187-195
• 8 Rosenberg J J, Fornage B D, Chevray P M. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.  Plast Reconstr Surg. 2006;  118 109-113