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The effect of abdominal wall plication on intra-abdominal pressure and lower extremity venous flow: a case report

Christopher J Pannucci1, Amy K Alderman, Sandra L Brown

  • 1Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA. cpannucc@umich.edu

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|August 23, 2011
PubMed

Abdominal wall plication is known to cause increased intra-abdominal pressure (IAP). Whether plication-associated increased IAP causes lower extremity venous stasis, a recognized risk factor for DVT, remains unknown. A 55-year-old woman had a unilateral pedicled TRAM procedure for mastectomy reconstruction. Prior to plication, duplex ultrasound measured proximal femoral vein (PFV) cross-sectional diameter and volume-flow. PFV measurements were repeated immediately after plication and on post-operative days (POD) 1, 2, and 4. Bladder pressure was measured at similar timepoints. PFV volume-flow decreased from 0.22 L/min to 0.16 L/min (73% of baseline) immediately post-plication and reached a nadir of 0.08 L/min (36% of baseline) on POD 2. Bladder pressure increased from 13 mm Hg to 19 mm Hg after plication, and peaked at 31 mm Hg after intra-operative trunk flexion to 30°. Thus, abdominal wall plication was associated with increased intra-abdominal pressure and ultrasound-documented lower extremity venous stasis that persisted for 48 h after surgery.

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