example3

Example 3. Intraoperative SPY Angiography Images from Patient A. Top: Image shows the anterior aspect of abdominal flap after the deep inferior epigastric perforators have been dissected on each side of the abdomen and the left-sided perforators were clamped. This was done to determine if a right extended hemiabdomen DIEP free flap can be utilized, but there is poor perfusion passed the midline. Middle: Image shows the posterior aspect of the right and left abdominal flaps flipped up, demonstrating poor fat perfusion after the left-sided perforators were clamped, preventing the use of the right extended hemiabdomen DIEP free flap. Bottom: Image demonstrates satisfactory flap perfusion after both the right and left deep inferior epigastric pedicles were anastomosed to the antegrade and retrograde internal mammary vessels at the recipient site before the inset. DIEP: Deep inferior epigastric perforator.