Summary
Abdominal wall plication is known to cause increased intra-abdominal pressure (IAP).
Whether plication-associated increased IAP causes lower extremity venous stasis, a
recognized risk factor for DVT, remains unknown. A 55-year-old woman had a unilateral
pedicled TRAM procedure for mastectomy reconstruction. Prior to plication, duplex
ultrasound measured proximal femoral vein (PFV) cross-sectional diameter and volume-flow.
PFV measurements were repeated immediately after plication and on post-operative days
(POD) 1, 2, and 4. Bladder pressure was measured at similar timepoints. PFV volume-flow
decreased from 0.22 L/min to 0.16 L/min (73% of baseline) immediately post-plication
and reached a nadir of 0.08 L/min (36% of baseline) on POD 2. Bladder pressure increased
from 13 mm Hg to 19 mm Hg after plication, and peaked at 31 mm Hg after intra-operative
trunk flexion to 30°. Thus, abdominal wall plication was associated with increased
intra-abdominal pressure and ultrasound-documented lower extremity venous stasis that
persisted for 48 h after surgery.
Keywords
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Article info
Publication history
Published online: August 22, 2011
Accepted:
August 4,
2011
Received:
August 1,
2011
Footnotes
☆Meeting disclosures: This work has not previously been presented at a regional or national meeting.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
