The branching pattern of the deep inferior epigastric artery revisited in-vivo: A new classification based on CT angiography

The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study’s goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. In this retrospective, single-center study, we enrolled patients scheduled for mastectomy and DIEP flap breast reconstruction, subjected to cCT within 24 months after CTa. We included 35 patients in the study. cCT accuracy was 95% (CI 0.80–0.98) in assessing the three largest perforators, 100% (CI 0.89–100) in assessing the dominant perforator, 93% (CI 0.71–0.94) in assessing the perforator intramuscular course, and 90.6% (CI 0.79–0.98) in assessing superficial venous communications. Superficial inferior epigastric artery (SIEA) caliber was recognized in 90% of cases (CI 0.84–0.99), with an excellent assessment of superficial inferior epigastric vein (SIEV) integrity (96% of cases, CI 0.84–0.99), and a lower accuracy in the evaluation of deep inferior epigastric artery (DIEA) branching type (85% of cases, CI 0.69–0.93). The mean X-ray dose spared would have been 788 ± 255 mGy/cm. Our study shows that cCT is as accurate as CTa in DIEP flap surgery planning.

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In-Vivo Quantitative Mapping of the Perforasomes of Deep Inferior Epigastric Artery Perforators

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000001960 ◽

2018 ◽

Vol 6 (10) ◽

pp. e1960

Author(s):

Rachael Leung ◽

Michael P. Chae ◽

Vicky Tobin ◽

David J. Hunter-Smith ◽

Warren M. Rozen

Keyword(s):

Inferior Epigastric Artery ◽

Quantitative Mapping ◽

Epigastric Artery ◽

Deep Inferior Epigastric Artery

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Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221592050 ◽

2012 ◽

Vol 94 (7) ◽

pp. 493-495 ◽

Cited By ~ 10

Author(s):

AR Molina ◽

ME Jones ◽

A Hazari ◽

I Francis ◽

C Nduka

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Diep Flap ◽

Branching Pattern ◽

Inferior Epigastric Artery ◽

Flap Loss ◽

Epigastric Artery ◽

Lateral Muscle ◽

Deep Inferior Epigastric Artery

INTRODUCTION The deep inferior epigastric perforator (DIEP) flap is currently viewed as the gold standard in autologous breast reconstruction. We studied three-dimensional computed tomography angiography (CTA) in 145 patients undergoing free abdominal flap breast reconstruction to try to correlate deep inferior epigastric artery (DIEA) branching pattern with the type of flap performed and patient outcome. Today, reconstructive breast surgeons have become more experienced in raising DIEP flaps and operative times are becoming more acceptable. However, there remains significant interest in finding ways to aid this challenging dissection. METHODS We retrospectively evaluated consecutive patients between January 2007 and August 2008. CTAs were analysed using the Moon and Taylor (1988) classification of the DIEA branching pattern. Data gathered included pre-operative morbidity, type of abdominal wall free flap performed, length of operation, length of stay and complications. RESULTS Some 150 breast reconstructions were performed in 145 patients. There were 67 DIEP flaps, 69 MS-2 transverse rectus abdominis myocutaneous (TRAM) flaps and 14 MS-1 TRAM flaps (where MS-1 spares the lateral muscle and MS-2 spares both lateral and medial segments). Proportionally more DIEP flaps were performed in patients with a type 2 branching pattern. There was one flap loss (0.67%). CONCLUSIONS In this large CTA series, we found a type 1 (single artery) DIEA pattern most frequently, in contrast to the predominance of the type 2 bifurcating pattern observed previously. The higher proportion of DIEP flaps performed in the type 2 pattern patients is consistent with the documented shorter intramuscular course in this group. We have found CTA useful for faster selection of the best hemiabdomen for dissection and flap loss rates in our unit have reduced from 1.5% to 0.67%.

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