Anatomy of superficial inferior epigastric vessels: revival of superficial inferior epigastric (SIEA) flap

Lohasammakul, Suphalerk; Turbpaiboon, Chairat; Ratanalekha, Rosarin; Lohsiriwat, Visnu; Chaiyasate, Kongkrit; Roham, Ali; Chuangsuwanich, Apirag

doi:10.1007/s00238-017-1349-0

Cited by 5 publications

(10 citation statements)

References 27 publications

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“…The former may limit the visualization and vessel detection in comparison to direct visualization by dissection or imaging study. 22 32 33…”

Section: Discussionmentioning

confidence: 99%

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Lohasammakul,

Tonaree,

Suppasilp

et al. 2023

J Reconstr Microsurg

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Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. Methods: Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory. Results: Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA with a diameter of ≥1.4 mm on either side (type 1a) supplied at least half the distance, whereas SIEA with a diameter of <1 mm (type 1b) was limited to the suprapubic area. Conclusions: Designing a SIEA flap island across the midline is feasible when contralateral SIEA is present to augment the contralateral territory (e.g., type 1a SIEA) or in SIEA with a common/superficial external pudendal artery origin. Preoperative imaging studies are important for confirming the SIEA system. When the diameter at the origin of the SIEA flap is larger than 1.4 mm, the blood supply to the ipsilateral and contralateral sides is sufficient to enable safe flap elevation.

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“…The former may limit the visualization and vessel detection in comparison to direct visualization by dissection or imaging study. 22 32 33…”

Section: Discussionmentioning

confidence: 99%

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Lohasammakul,

Tonaree,

Suppasilp

et al. 2023

J Reconstr Microsurg

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“…Within 2–3 cm of crossing the inguinal ligament, the SIEA pierces Scarpa’s fascia to become superficial and run in the subcutaneous tissue. 7 Perforating branches are given off until the level of the umbilicus, providing a robust skin paddle particularly in obese patients. 7 However, to our knowledge, reports on the use of the SIEA flap for extremity defects in the literature all seemingly describe full-thickness harvest, from the abdominal wall to the skin, in thinner patients.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Perforating branches are given off until the level of the umbilicus, providing a robust skin paddle particularly in obese patients. 7 However, to our knowledge, reports on the use of the SIEA flap for extremity defects in the literature all seemingly describe full-thickness harvest, from the abdominal wall to the skin, in thinner patients. 8 , 9 In these cases, primary thinning was not performed, at times requiring significant debulking liposuction months later.…”

Section: Discussionmentioning

confidence: 99%

The SIEA SHRIMP Flap: An Ultrathin Axial Pattern Free Flap Useable in Obese Patients

Felder

Willborg

Zhu

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: The reconstruction of distal extremity wounds poses a unique surgical challenge. In free tissue transfer, a thin, pliable skin flap is the ideal. Obese patients have a paucity of thin skin donor sites. Herein we report the discovery of a free SHRIMP flap (Superthin Harvest of a Reliable Islanded Medial Pannus flap) based on the SIEA vessels, harvested from a thick abdominal pannus at the time of cosmetic abdominoplasty. A 61-year-old woman with a chronic wound of the right Achilles tendon was evaluated for reconstruction after failing conservative measures. At the time of consultation, the patient expressed interest in abdominoplasty. Therefore, a skin flap from the abdomen or rectus abdominis muscle flap in the context of an abdominoplasty was offered. Despite obesity affecting the pannus, the superficial inferior epigastric vessels were found to course superficially beneath the dermis at time of abdominoplasty. This allowed straightforward harvest of a superthin flap of skin and minimal subcutaneous fat, which contoured to the ankle with an aesthetically pleasing outcome. The patient was satisfied with the results of her abdominoplasty and coverage of her chronic wound. The SHRIMP flap provides a straightforward, axial pattern, superthin free skin flap based on the superficial inferior epigastric vessels, and represents a useful option in obese patients. The flap can be combined with abdominoplasty for an aesthetic donor site.

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“…An arterial diameter of 1.5 mm 3 is the established threshold for reliable flap transfer and survival, and the SIEA has been found to not meet this criterion in 56% to 70% of the patients. 8,9,16,17 Preoperative imaging, intraoperative algorithms, and flap modifications have been implemented to improve SEIA flap success rates. 9,18 The delay phenomenon, in which vessels surrounding the main pedicle are ligated to augment the pedicle's blood supply, may be a successful approach to augment the SIEA diameter, flow, and vascular territory.…”

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confidence: 99%

“…A major barrier to the SIEA flap's widespread use is its small caliber. An arterial diameter of 1.5 mm 3 is the established threshold for reliable flap transfer and survival, and the SIEA has been found to not meet this criterion in 56% to 70% of the patients 8,9,16,17 …”

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confidence: 99%

Surgical Delay-Induced Hemodynamic Alterations of the Superficial Inferior Epigastric Artery Flap for Autologous Breast Reconstruction

Hoffman¹,

Maddox

Meade

et al. 2022

Ann Plast Surg

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Background The superficial inferior epigastric artery (SIEA) flap allows transfer of tissue without violating the rectus fascia. Traditionally it is best used in single stage reconstruction when vessel caliber is 1.5 mm; 56% to 70% of SIEAs are less than 1.5 mm and, therefore, not reliable. We aim to demonstrate the increased reliability of SIEA through surgical delay by quantifying reconstructive outcomes and delay-induced hemodynamic alterations. Methods Patients presenting for autologous breast reconstruction between May 2019 and October 2020 were evaluated with preoperative imaging and received either delayed SIEA or delayed deep inferior epigastric (DIEP) reconstruction based on clinical considerations, such as prior surgery and perforator size/location. Prospective data were collected on operative time, length of stay, and complications. Arterial diameter and peak flow were quantified with Doppler ultrasound predelay and postdelay. Results Seventeen delayed SIEA flaps were included. The mean age (± SD) was 46.2 ± 10.55 years, and body mass index was 26.7 ± 4.26 kg/m2. Average hospital stay after delay was 0.85 ± 0.90 days, and duration before reconstruction was 6 days to 14.5 months. Delay complications included 1 abdominal seroma (n = 1, 7.7%). Superficial inferior epigastric artery diameter predelay (mean ± 95% confidence interval) was 1.37 ± 0.20 mm and increased to 2.26 ± 0.24 mm postdelay. A significant increase in diameter was noted 0.9 ± 0.22 mm (P < 0.0001). Mean peak flow predelay was 14.43 ± 13.38 cm/s and 44.61 ± 60.35 cm/s (n = 4, P = 0.1822) postdelay. Conclusions Surgical delay of the SIEA flap augments SIEA diameter, increasing the reliability of this flap for breast reconstruction. Superficial inferior epigastric artery delay results in low rates of complications and no failures in our series. Although more patients are needed to assess increase in arterial flow, use of surgical delay can expand the use of SIEA flap reconstruction and reduce abdominal morbidity associated with abdominal flap breast reconstruction.

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Anatomy of superficial inferior epigastric vessels: revival of superficial inferior epigastric (SIEA) flap

Cited by 5 publications

References 27 publications

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

The SIEA SHRIMP Flap: An Ultrathin Axial Pattern Free Flap Useable in Obese Patients

Surgical Delay-Induced Hemodynamic Alterations of the Superficial Inferior Epigastric Artery Flap for Autologous Breast Reconstruction

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