Arterial and Venous Anatomies of the Deep Inferior Epigastric Perforator and Superficial Inferior Epigastric Artery Flaps

Schaverien, Mark V.; Saint‐Cyr, Michel; Arbique, Gary; Brown, Spencer A.

doi:10.1097/prs.0b013e31817151f8

Cited by 166 publications

(101 citation statements)

References 26 publications

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“…[3][4][5][6][7] Anatomic studies have shown that the deep inferior epigastric vein (DIEV) connects with the superficial inferior epigastric vein (SIEV) through a system of choke vessels within the flap. [8] In numerous studies, the superficial venous system has been used to adequately decongest the flap in cases where venous congestion was clinically observed [9][10][11][12][13]. We have found that routinely anastomosing both the superficial and deep venous systems has resulted in significantly fewer operative take-backs and decreased venous complications with use of the DIEP flap.…”

Section: Introductionmentioning

confidence: 83%

“…A system of choke vessels exists between the superficial inferior epigastric vein and the deep inferior epigastric system; however, certain variations in anatomy may exist. [8] Venous branches crossing the midline have been found to be absent in 36% of cases [4,14]. This paucity of crossing branches explains why survival of Zone IVof the flap can be quite unpredictable.…”

Section: Discussionmentioning

confidence: 99%

“…Venous drainage is thus rerouted to the perforating veins through choke vessels [8]. However, there are cases where the DIEP flap is more dependent on superficial drainage.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Boutros¹,

Martínez²

2016

Breast Reconstruction

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Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Boutros¹,

Martínez²

2016

Breast Reconstruction

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“…2 Estudos experimentais sobre a vascularização dos vários retalhos miocutâneos e seu território vascular, principalmente do plexo da epigástrica inferior, contribuíram consideravelmente para melhores resultados. [3][4][5][6][7] Alguns trabalhos utilizaram fármacos para avaliar a perfusão e a necrose desses retalhos. 8 Assim, para efetuar uma maior vascularização nesses retalhos, alguns cirurgiões começaram a realizar a "flap delay" (autonomização) 7,9-10 em referência ao chamado "delay phenomenon".…”

Section: Introductionunclassified

Retalho do músculo reto abdominal transverso autonomizado em pacientes obesas e fumantes

Gonella

Portella

2016

Rev. Fac. Ciênc. Méd. Sorocaba

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RESUMOIntrodução: A reconstrução mamária foi difundida no fim da década de 1970 e no início da de 1980. Nas reconstruções mamárias realizadas por meio do retalho do músculo reto abdominal transverso (TRAM), principalmente em pacientes obesas e fumantes, ocorriam necroses parciais ou totais. Estudos experimentais contribuíram muito para minimizar a necrose, que chegou a cerca de 16%. Porém, nas obesas e fumantes, continuava alarmante o índice de necroses (75%). Alguns autores começaram a realizar embolização ou laqueadura das epigástricas inferiores. Objetivo: O objetivo deste trabalho foi apresentar como fazer a autonomização e seus resultados. Método: Estudo retrospectivo de 13 pacientes, nas quais se utilizou a técnica referida. Foram analisadas por meio dos métodos de Student e Tukey, apresentando sua significância. Resultados: Um paciente apresentou epidermólise. Discussão: Dessa forma, a autonomização propicia uma série de fenômenos que resultam, na maioria das vezes, após período de 10 a 21 dias, no aumento da vascularização local. Conclusão: As táticas cirúrgicas de autonomizar o TRAM e realizar a transposição após 15 dias mostraram-se eficazes. Palavras-chave: mamoplastia; reto do abdome; retalhos cirúrgicos; obesidade; hábito de fumar.ABSTRACT Introduction: Post-Mastectomy Breast reconstruction became popular in the late 1970s and early 1980s. At these surgeries through Transverse Rectus Abdominus Myocutaneous flap (TRAM), mainly in obese and smoking patients, it was demonstrated areas of partial or total necrosis. Experimental studies contributed in many ways to minimize these complications to 16%. But the necrosis occurrence was still high in obese and smoking patients (75%). A few authors began to do embolization or ligature at inferior epigastric plexus. Objective: This study aim is to show a way to make surgical delay of TRAM flap and its results. Methods: Retrospective study from 13 patients, in which this technic was performed. They were analyzed through Student and Tukey methods, presenting its statistical significance Results: One single patient presented epidermolysis. Discussion: The flap delay creates several local exchanges that results, usually after 10 to 21 days, at the increase of local vascular structures. Conclusion: Surgical delay of the TRAM flap as a surgical tactic and its definitive reconstruction after 15 days has been effective. Keywords: mammoplasty; rectus abdominis; surgical flaps; obesity; smoking. INTRODUÇÃOTanzini apresentou a técnica de reconstrução mamária através do músculo grande dorsal em 1896. Bostwick revitalizou essa técnica nos fins da década de 1970. A reconstrução mamária por meio do retalho do músculo reto abdominal transverso (TRAM, em inglês: Trans Rectal Abdominal Muscle) surgiu na década de 1980. Nos eventos das Sociedades de Mastologia e da Cirurgia Plástica, ocorriam inúmeras discussões sobre a vascularização do retalho retoabdominal, realizada pelas artérias epigástricas superiores e inferiores. Como esse retalho é ilhado, abrangendo um leque de pele e...

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“…Despite the potential benefits, the use of this flap has been limited in breast reconstruction when compared with the deep inferior arterybased flaps. Cited reasons for this include: that typical perfusion only supports an ispilateral hemiabdomen (3,(5)(6)(7); the SIEA vessels have been cut preoperatively in many cases due to previous pfannenstiel incisions; and the diameter of the artery is believed to be of insufficient size to reliably complete a successful microvascular anastomosis. The highest reported rate of use of the SIEA flap versus the DIEA-based flaps has been in the 30% range (3,5,8,9).…”

mentioning

confidence: 99%

Rethinking the superficial inferior epigastric artery flap in breast reconstruction: Video demonstration of a rapid, reliable harvest technique

Buchel¹,

Dalke²,

Hayakawa³

2013

CAN J PLAST SURG

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T he majority of autologous free flap breast reconstruction uses tissue from the lower anterior abdominal wall. Traditionally, this involved harvesting the entire ipsilateral or bilateral rectus abdominus muscles while incorporating them into the transverse rectus abdominus flap (TRAM flap). Recently, lower abdominal wall flap elevation has evolved from complete rectus abdominus muscle resection to limited muscle harvest and finally to perforator flap harvest. The deep inferior epigastric artery perforator (DIEP) flap is now considered to be one of the least debilitating harvest techniques routinely used in breast reconstruction. This perforator flap uses the deep inferior epigastric artery and venea comitantes to perfuse varying degrees of the lower abdominal wall skin and fat, without intentional harvest or destruction of any rectus abdominus muscle. However, a DIEP flap harvest damages the anterior rectus fascia in all cases, and intermittently transects or causes significant neuropraxia of the intercostal nerves, particularly if more than one perforator is required. In addition, the longer the vascular pedicle harvest, the longer the fascia incision, and the greater the chance of intercostal nerve damage. This can lead to increased pain, lower abdominal wall bulging and hernia development (1-4).The superficial inferior epigastric artery (SIEA) flap uses a medially located vein -the superficial epigastric artery -and, rarely, its associated venea to reliably perfuse the ipsilateral hemiabdominal wall skin and fat. The anterior abdominal wall fascia is left intact in all cases. This technique all but eliminates the possibility of an iatrogenic anterior abdominal wall hernia. Pain is also typically decreased because the muscle, fascia and nerves to the anterior abdominal wall are left intact. Despite the potential benefits, the use of this flap has been limited in breast reconstruction when compared with the deep inferior arterybased flaps. Cited reasons for this include: that typical perfusion only supports an ispilateral hemiabdomen (3,5-7); the SIEA vessels have been cut preoperatively in many cases due to previous pfannenstiel incisions; and the diameter of the artery is believed to be of insufficient size to reliably complete a successful microvascular anastomosis. The highest reported rate of use of the SIEA flap versus the DIEA-based flaps has been in the 30% range (3,5,8,9). Yet, the presence of the SIEA and venea, and the SIEV of sufficient calibre has been documented in anatomical studies to be available in nearly 75% of cases (10).Over the past 10 years, our use of the SIEA flap has progressed from a rare event to more than 35% of all abdominal wall-based autologous breast reconstructions performed at our institution. The change in harvest technique and the algorithm for selection are described below with video documentation of the technique. Lower abdominaL waLL-based autoLogous tissue harvest aLgorithmThe algorithm for deciding whether to use a SIEA flap is based on the following considerations. Fi...

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Arterial and Venous Anatomies of the Deep Inferior Epigastric Perforator and Superficial Inferior Epigastric Artery Flaps

Abstract: This study demonstrates that flow through medial and lateral row perforators occurs in physiologically stereotyped patterns. A medial row perforator should be selected if zone IV perfusion is required. The SIEA was consistently seen to only perfuse a hemiflap.

Cited by 166 publications

References 26 publications

Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Double Venous System Drainage in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Retalho do músculo reto abdominal transverso autonomizado em pacientes obesas e fumantes

Rethinking the superficial inferior epigastric artery flap in breast reconstruction: Video demonstration of a rapid, reliable harvest technique

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