Arterial thrombosis caused by arteriosclerotic lesion of the deep inferior Epigastric artery in the free rectus abdominis musculocutaneous flap

(Background) The deep inferior epigastric artery (DIEA) is a feeding artery for the rectus abdominis musculocutaneous flap. Because of its width, the DIEA is easily anastomosed to the recipient vessel and because of its length it is versatile enough to be used in many surgical situations. Plastic surgeons regard it as a reliable vessel, and use it frequently. Here, however we report an arteriosclerotic lesion of the deep inferior epigastric artery during head and neck reconstruction. (Case) The patient is a 66 year-old man diagnosed with a squamous cell carcinoma at the external acoustic meatus of his right ear. After the tumor resection and neck dissection, we applied an oblique abdominal musculocutaneous flap to the large skin defect on the right temporal lesion. Immediately after the DIEA was anastomosed to the ipsilateral transverse cervical artery, an arterial thrombosis occurred. Upon touching the DIEA, a hard lesion was found at its proximal side and the lesion was replaced with a vein graft. After that, the flap survived. The pathological diagnosis was a lesion with medial arterial calcification. (Conclusion) There are two different types of vascular calcification : atherosclerotic calcification and medial arterial calcification. Here, we report the arterial calcification of the DIEA. We should consider the possibility of arteriosclerosis, when the DIEA is anastomosed.