Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction

Abstract

Objective: To suggest the best location of the perforator and cutaneous nerve for strategic design of the deep inferior epigastric perforator (DIEP) flap. Materials and methods: The characteristic of the pedicles, perforators, intercostal nerves and the relationship of nerve to vessel in DIEP flap were studied in 31 formalin-preserved cadavers (62 flaps). Results: 405 perforator vessels were divided into three vertical rows. These perforators were mostly contained in medial row (45.4%) while the lateral row perforators were the largest (1.0+-0.3 mm). The largest perforator (1.4+-0.3 mm) were mostly located within 1 cm horizontally from umbilicus. Lateral row perforators, usually rectilinear course (82.7%), traveled with nerves from the beginning. Whereas medial row perforators, usually oblique course (86.4%), were not related to nerves initially but they joined together before piercing to the rectus sheath. Conclusion: Our finding suggested that it would be more beneficial to using the lateral row perforators.