Temporary AV-shunt for auxiliary microvascular anastomoses of the TRAM or VRAM flap in breast reconstruction —the turbo-charged flap

Despite careful dissection of the inferior epigastric vessels, pedicle length is usually found to be uncomfortably short, often necessitating the interpositioning of vein grafts when an axillary anastomosis is to be performed. Creating a temporary cephalic vein loop to either the circumflex scapulae or the pectoral branch of the acromioclavicular artery greatly facilitates the microvascular anastomoses without undue prolongation of operating time. Auxiliary microvascular anastomoses of the more dominant inferior epigastric vessels is proposed as an additional safeguard in cases where a disturbed bloodflow pattern after transpositioning the pedicled island TRAM or VRAM flap is found.