Premium
PR15
THE BRANCHING PATTERN OF THE DIEA FOR PERFORATOR FLAPS: THE IMPORTANCE OF PREOPERATIVE CT ANGIOGRAPHY
Author(s) -
Rozen W. M.,
Phillips T. J.,
Ashton M. W.,
Stella D. L.,
Taylor G. I.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04127_15.x
Subject(s) - medicine , rectus abdominis muscle , perforator flaps , diep flap , branching (polymer chemistry) , cadaver , computed tomography angiography , anatomy , angiography , breast reconstruction , abdominal wall , radiology , nuclear medicine , materials science , cancer , breast cancer , composite material
Purpose Abdominal donor site flaps are the standard in autologous breast reconstruction. With significant variation in the vascular anatomy of the abdominal wall, preoperative imaging is essential. Computerised Tomography Angiography (CTA) has been recently described for this purpose. Uniquely, the branching pattern of the Deep Inferior Epigastric Artery (DIEA) is demonstrated clearly on CTA. We sought to correlate the branching pattern of the DIEA to the location and course of perforators, as a tool for preoperative planning. Methodology 45 hemi‐abdominal walls from both fresh and embalmed cadavers were used for isolated injection of the DIEA with contrast and radiographic imaging, allowing analysis of the location and intramuscular course of the perforators. The branching pattern on radiography was thus correlated to individual perforators. Results DIEA branching pattern correlated closely with the intramuscular course of perforators. A bifurcating branching pattern demonstrated a reduced intramuscular transverse distance traversed by each perforator. A trifurcating (Type 3) branching pattern demonstrated perforators that traversed significantly greater transverse distances. The vessel type, however, displayed no correlation with the number of perforators. Conclusions Intramuscular courses of perforators are significantly greater with a trifurcating branching pattern of the DIEA, and reduced with a bifurcating pattern. This correlates with less rectus abdominis muscle sacrificed during a DIEA perforator flap. As CTA is the optimal modality for demonstrating this pattern preoperatively, we suggest the use of CTA for preoperative assessment in TRAM and DIEA perforator flaps.