Encountering Peritoneo-Cutaneous Perforators in Microsurgical DIEP Flap Breast Reconstruction

Author:

Loi Duncan12ORCID,Easton Justin L.12ORCID,Rozen Warren M.12ORCID

Affiliation:

1. Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia

2. Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia

Abstract

AbstractThe vascular anatomy of the deep inferior epigastric artery perforator (DIEP) flap has been well studied in the planning for autologous breast reconstruction. Preoperative imaging with computed tomography angiography (CTA) provides accurate assessment of this vascular anatomy, which varies widely across patients. Several papers to date have described their encounter with an anomalous “epiperitoneal” or “peritoneo-cutaneous” perforator during flap harvest, a perforator that pierces the posterior rectus sheath from a peritoneal origin, to traverse rectus abdominis and supply the DIEP flap integument. In the course of over 3,000 CTA assessments of the vascular anatomy of the abdominal wall, we have encountered dominant peritoneo-cutaneous perforators in 1% of cases, and smaller perforators seen in many more cases, approaching 5% of cases. With increasing sensitivity of imaging, we also describe a unique case of multiple large bilateral peritoneo-cutaneous perforators, and present these findings in the context of DIEP flap harvest. It is critical to recognize these peritoneo-cutaneous perforators preoperatively to avoid mistaking them for a DIEP during the raising of a DIEP flap. The routine use of preoperative CTA enables the safe identification of individual vascular anatomy, including significant peritoneo-cutaneous perforators.

Publisher

Georg Thieme Verlag KG

Subject

Surgery

Reference10 articles.

1. Vascular anatomy of the deep inferior epigastric artery perforator flap: a systematic review;J E Ireton;Plast Reconstr Surg,2014

2. Abdominally based free flap planning in breast reconstruction with computed tomographic angiography: systematic review and meta-analysis;R Ohkuma;Plast Reconstr Surg,2014

3. Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?;W M Rozen;Microsurgery,2008

4. Epiperitoneal vessels: more resources to perform DIEP flaps;J M Lasso;J Plast Reconstr Aesthet Surg,2008

5. Atypical patterns of deep inferior epigastric artery: clinical implication of preoperative CT angiography;L Taek Jong;J Korean Soc Microsurg,2012

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