Flap pedicle vena comitant as a vein graft donor source

A vena comitant segment harvested from a flap's pedicle can be used as an interpositional vein graft in selected microvascular cases. When a vascular pedicle includes paired venae comitantes, one of these can prove suitable for use as a vein graft while still allowing for venous outflow of the flap. An additional operative site and procedure to harvest a vein graft can be avoided if a vena comitant segment can be used. We present eight cases in which pedicle vena comitant segments were used as interpositional vein grafts. In six cases, vena comitant grafts were used to supercharge or augment venous outflow in transverse rectus abdominis myocutaneous (TRAM) flaps used for breast reconstruction. A vena comitant graft was used to revise the venous anastomosis in one deep inferior epigastric perforator (DIEP) flap. The arterial anastomosis was revised with a vena comitant graft in a gracilis muscle free flap. Our experience demonstrates the viability and utility of using the flap pedicle's vena comitant as a source of vein graft in selected cases.