Utilising the Flap Vein of a Pedicled TRAM Flap for LYMPHA: A Case Report

Upper extremity lymphedema is a common and disabling complication of breast cancer treatment, especially following axillary lymph node dissection (ALND). Its risk may be reduced with the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) procedure, which involves anastomosis of one or more upper limb lymphatic channels to a recipient vein, usually a branch of the axillary vein within the axilla. However, these branches may sometimes be difficult to identify or even not be in suitable condition, especially if extensive electrocautery was used during ALND. If autologous breast reconstruction is performed simultaneously, a flap vein may serve as a reliable recipient vein for anastomosis. We describe a simple and potentially useful technique of utilizing the flap vein (deep inferior epigastric vein) of a pedicled transverse rectus abdominis myocutaneous flap, as a recipient vein for the lymphaticovenular anastomosis in LYMPHA.