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The Impact of Deferoxamine on Vascularity and Soft-Tissue Biomechanics in a Rat TRAM Flap Model.

125e The Impact of Deferoxamine on Vascularity and Soft-Tissue Biomechanics in a Rat TRAM flap Model Sir: I flap vascularity can lead to partial or total flap necrosis, tissue fibrosis and stiffness, infection, and a poor aesthetic result. Numerous agents have been used both clinically and experimentally in an attempt to improve tissue vascularity. Recent reports include the use of hyperbaric oxygen, shockwave therapy, parathyroid hormone, vascular endothelial growth factor, tadalafil, and vinpocetine, among others, to mitigate ischemia and prompt angiogenesis. Deferoxamine is a U.S. Food and Drug Administration–approved iron-chelating medication that has also been shown to increase the growth of new blood vessels through its ability to up-regulate hypoxia-inducible factor-1α, a key transcription factor for several genes important for angiogenesis.1 Deferoxamine has been shown to augment bone vascularity; however, periareolar incision. No complication occurred during surgery, and intraoperative bleeding was low. One suction drain was placed on each side. The following day, drainage was 30 and 40 cc, respectively, and drains could be removed. The mammary result was good. The patient complained of mild dyspnea and left back pain. A chest radiograph and computed tomographic scan were obtained to determine a mechanical problem versus a pulmonary complication and revealed a left pleural effusion (Fig. 1, above). A drain aspiration technique was applied immediately, with insertion of chest tubes into the thoracic cavity. The drain was left in place for 5 days, and 2 serohematic liters were removed (Fig. 1, below). The source of bleeding could not be identified, the patient had no sequelae, and no transfusion was needed. Hemothorax represents an emergency situation. Therefore, prompt treatment is required. As this complication has never been described after breast augmentation, its precise cause is difficult to determine in this context. Pulmonary embolism was ruled out by computed tomographic angiography. Two hypotheses can be made. The first is a spontaneous hemothorax in a susceptible patient. However, no risk factor was found.4 The second is a retraction of the intercostal perforator artery with retrocostal bleeding. This hypothesis seems most likely, even if no active bleeding was identified intraoperatively or postoperatively. We suggest that patients should always be informed of Fig. 1. (Above) Computed tomographic scan demonstrating the left hemothorax after breast augmentation. (Below) solved hemothorax after placement of chest tubes. the risk of pulmonary complication such as pneumothorax or hemothorax before cosmetic breast surgery. Surgeons and anesthesiologists should be aware of its symptoms and be prepared for emergency treatment. DOI: 10.1097/PRS.0000000000001360