Delaying the superficial inferior epigastric artery flap: A solution to the problem of the small calibre of the donor artery

Bilateral Free Flap Breast Reconstruction Outcomes: Do Abdominal Scars Affect Bilateral Flaps?

“…Conversely, some studies found that Pfannenstiel scar was associated with larger perforators and may potentially augment the perfusion of the lower abdomen by promoting the development of collateral pathways of circulation via delayed-phenomenon mechanisms, 10 , 13 similar to those utilized in SIEA delay procedures. 14 However, there was no reported difference between the presence or absence of usable SIEA vessels in patients with abdominal scars described in the operative reports. There is also a hypothesis that improved perfusion in multiparous women may be attributed to pregnancy per se rather than delivery via Caesarian section and subsequent scar.…”

SIEA versus DIEP Arterial Complications

“…12 A delay procedure involving ligation of the ipsilateral DIEA has been proposed to augment SIEA diameter. 21 We followed consistent intraoperative criteria for SIEA flap selection. Other intraoperative algorithms for performing a SIEA flap without requirement of preoperative imaging are reported with success.…”

“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

“…Indeed, a recent study has suggested that SIEA pathways may be amplified through the ligation of the DIEA. Currently, only 20–30% of women who require autologous breast reconstructions are able to receive the SIEA flap because of the tenuous and highly variable nature of the blood supply to the SIEA (Gregorič et al, 2011; Piorkowski etal., 2011). Through ligating the DIEA as part of the delay procedure, surgeons could theoretically augment the blood supply of the SIEA preoperatively, and thereby increase the applicability and reliability of the SIEA flap in a greater number of patients.…”

“…Through ligating the DIEA as part of the delay procedure, surgeons could theoretically augment the blood supply of the SIEA preoperatively, and thereby increase the applicability and reliability of the SIEA flap in a greater number of patients. In fact, a recently completed Phase II clinical trial concluded that ligating any one of the three main arterial supplies to the lower abdomen (DIEA, SIEA, and SCIA) will result in increased caliber and flow of the remaining arteries supplying the same angiosome (Gregorič et al, 2011). This lends significant support to the clinical potential of ligating the DIEA as a delay procedure for free flap breast reconstructions, which could have landmark significance in the development of the ways in which delay procedures can be, and are, performed in this context.…”