Importance of Lateral Row Perforator Vessels in Deep Inferior Epigastric Perforator Flap Harvesting
- 1 February 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 113 (2), 517-524
- https://doi.org/10.1097/01.prs.0000100812.37842.a8
Abstract
Free flaps based on perforator vessels, and in particular the deep inferior epigastric perforator (DIEP) flap, are currently being applied in abdominal reconstruction. However, one of the main disadvantages is the operative complexity. Through anatomical study and clinical experience with the DIEP flap in breast reconstruction, the intramuscular path of the perforator vessels was comparatively studied, to establish the main anatomical parameters that favor procedure planning. Thirty DIEP flaps from 15 fresh cadavers were used. The number, location, and intramuscular course of the perforator vessels were determined. In addition, an initial clinical study was performed in 31 patients using 35 DIEP flaps in breast reconstruction. The number, location, and the intramuscular course of the perforators were assessed. In the cadaver study, 191 perforator vessels were detected (6.4 vessels per flap). Thirty-four percent were located in the lateral row, and the rectilinear course was observed in 79.2 percent of these vessels. In the medial row, only 18.2 percent of the perforator vessels presented this configuration (p = 0.001). Thirty-one patients underwent DIEP flap breast reconstruction, with 26 immediate and four bilateral reconstructions. In 22 of 35 flaps (62.9 percent), two perforators were used. In 25 flaps (71.4 percent), the lateral row perforators with a rectilinear course were observed. Mean operative time was 7 hours and 37 minutes. Two total flap losses and two partial necroses were observed. The majority of the lateral row perforators presented a rectilinear intramuscular course, which was shorter than that of the medial row perforators. This anatomical characteristic favors dissection with reduced operative time and vascular lesion morbidity, resulting in an important anatomical parameter for DIEP flap harvesting.Keywords
This publication has 16 references indexed in Scilit:
- The fate of the oblique abdominal muscles after free TRAM flap surgeryBritish Journal of Plastic Surgery, 1997
- Deep Inferior Epigastric Perforator Flap for Breast ReconstructionAnnals of Plastic Surgery, 1994
- Immediate TRAM Flap Breast ReconstructionPlastic and Reconstructive Surgery, 1993
- Immediate Breast Reconstruction: Why the Free TRAM Over the Conventional TRAM Flap?Plastic and Reconstructive Surgery, 1992
- Comparison of Strategies for Preventing Abdominal-Wall Weakness after TRAM Flap Breast ReconstructionPlastic and Reconstructive Surgery, 1992
- The Transverse Rectus Abdominis Musculocutaneous Free Flap: A Reliable Alternative for Delayed Autologous Tissue Breast ReconstructionAnnals of Plastic Surgery, 1990
- Breast reconstruction: Progress in the past decadeWorld Journal of Surgery, 1990
- Inferior epigastric artery skin flaps without rectus abdominis muscleBritish Journal of Plastic Surgery, 1989
- Conventional TRAM Flap versus Free Microsurgical TRAM Flap for Immediate Breast ReconstructionPublished by Ovid Technologies (Wolters Kluwer Health) ,1989
- A Critical Review of 300 PatientsAnnals of Surgery, 1987