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Arch Hand Microsurg > Volume 23(4); 2018 > Article
Archives of Hand and Microsurgery 2018;23(4):281-289.
Published online December 1, 2018.
DOI: https://doi.org/10.12790/ahm.2018.23.4.281   
Classification of Deep Inferior Epigastric Perforator Courses Based on Computed Tomography Angiography: Incidences and Clinical Implications
Yeonhoon Lee1, Sung Chan Kim2, Jin Sup Eom1, Eun Key Kim1
1Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. nicekek@korea.com
2Woori Plastic Surgery Clinic, Seoul, Korea.
Received: 25 July 2018   • Revised: 11 September 2018   • Accepted: 17 September 2018
Abstract
Purpose
Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning.

Methods
The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated.

Results
A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen.

Conclusion
Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.
Key Words: Breast reconstruction, Perforator flaps, Computed tomography angiography
 


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