Neurovascular Anatomy of the Deep Inferior Epigastric Perforator Flap for Breast Reconstruction
Tanvaa Tansatit MD*, Prayuth Chokrungvaranont MD**, Pasinee Sanguansit MSc*, Samang Wanidchaphloi MSc*
Affiliation : * Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University ** Unit of Plastic Surgery, Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University
Objective : To find out the most suitable perforator and cutaneous nerve for strategic design of the deep inferior
epigastric perforator (DIEP) flap.
Materials and Methods : The characteristics of the pedicles, perforators, intercostal nerves and the relationship
between nerves and vessels in DIEP flaps were studied in 31 formalin-preserved cadavers.
Results : Four hundred and five perforator vessels were divided into three vertical rows. These perforators
were mostly contained in the medial row (45.4%), the average size of the perforators in the lateral row was the
largest (1.0 + 0.3 mm). The largest perforators (1.4 + 0.3 mm) were mostly located within 1 cm horizontally
from the umbilicus. Lateral row perforators, usually rectilinear course (82.7%), traveled with nerves from the
beginning. Whereas, the perforators in the medial row usually coursed obliquely (86.4%) and were not
related to nerves initially, they joined before piercing the rectus sheath.
Conclusion : The present findings indicate that it would be more beneficial to use the lateral row perforators.
Keywords : Deep inferior epigastric perforator (DIEP) flap, Breast reconstruction
