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Case Reports in Surgery
Volume 2016, Article ID 9168154, 4 pages
Case Report

Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus

1School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
2Plastic & Reconstructive Surgery Department, Addenbrooke’s University Hospital, Cambridge CB2 0QQ, UK
3Cambridge Breast Unit, Addenbrooke’s University Hospital, Cambridge CB2 0QQ, UK
4Postgraduate Medical Institute, Faculty of Health Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK

Received 14 April 2016; Accepted 25 July 2016

Academic Editor: Yehuda Ullmann

Copyright © 2016 Joseph W. Duncumb et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer.