Superior Epigastric Artery Perforator Flap: Anatomy, Clinical Applications, and Review of Literature

Abstract

The SEAP flap provides a useful approach for reconstruction of defects of the anterior chest, or of the abdominal wall. As a perforator or adipocutaneous flap, the flap is reliable and easy to raise, and spares donor site morbidity.

Thoracodorsal Artery Perforator and Superior Epigastric Artery Perforator Flaps for Volume Replacement Oncoplastic Breast Surgery

“…A safe length of a perforator flap depends on many factors such as perforator diameter, location, and orientation in the soft tissue. 2 In a transversely designed flap, the flap’s length-to-width ratio should be 1:2.5 or less, and a safe lateral limit of the flap is the posterior axillary line. 22 According to Hamdi et al, the zone lateral to the anterior axillary line is mainly supplied by the posterior intercostal arteries, and this is the zone that has contributes to flap tip necrosis in transversely designed flaps.…”

“…Vertical SEAP flaps can be extended safely up to the level of the umbilicus. 2 According to Hamdi et al and Uemura, the zone below the midpoint between the xiphoid process and the umbilicus is supplied primarily by the deep inferior epigastric artery perforator, which contributes to tip necrosis in the vertical SEAP flap. 12 23 Distal flap necrosis should be considered while planning a SEAP flap, especially in vertically oriented flaps, because of more proximal perforators, or venous congestion, possibly due to imbalanced choke vessel communication.…”

“…21 24 A vertical flap design might be safer for more caudally located perforators or a reduced vertical flap length. 2 We raised a vertical flap up to the level of umbilicus without any distal flap necrosis. The factors that are considered to be important while raising an SEAP flap are location of the defect, size of the defect relative to breast size, location of the perforators, design of flap, and length of the flap.…”

“…Traditionally, latissimus dorsi (LD) flaps have been the one-stop solution workhorse for these defects. 2 Perforator based flaps, thoracodorsal artery perforator (TDAP) flap, lateral intercostal artery perforator flap, anterior intrercostal artery perforator (AICAP) flap, and superior epigastric artery perforator (SEAP) flap sparing the underlying muscle are the next step in the evolution. 3 We present our initial experience with TDAP and SEAP flaps used for selective indications.…”

Effects of Sanguis Draconis on Perforator Flap Survival in Rats

“…Perforator flaps were first described by Koshima in 1989, and began to be widely used for the reconstruction of soft tissue defects when plastic surgeons recognized their usefulness as freestyle island flaps [1,2]. Various perforator flaps with versatile designs have been developed to replace the traditional flaps and reduce donor morbidity [3,4]. However, these “designed” perforator flaps are known for their short survival and deficient blood perfusion [5].…”