Arch Hand Microsurg.  2018 Dec;23(4):281-289. 10.12790/ahm.2018.23.4.281.

Classification of Deep Inferior Epigastric Perforator Courses Based on Computed Tomography Angiography: Incidences and Clinical Implications

Affiliations
  • 1Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. nicekek@korea.com
  • 2Woori Plastic Surgery Clinic, Seoul, Korea.

Abstract

PURPOSE
Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning.
METHODS
The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated.
RESULTS
A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen.
CONCLUSION
Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.

Keyword

Breast reconstruction; Perforator flaps; Computed tomography angiography

MeSH Terms

Angiography*
Classification*
Epigastric Arteries
Female
Free Tissue Flaps
Hand
Humans
Incidence*
Mammaplasty
Perforator Flap
Prospective Studies
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