Perforasomes of the DIEP Flap: Vascular Anatomy of the Lateral versus Medial Row Perforators and Clinical Implications

Wong, Corrine; Saint‐Cyr, Michel; Mojallal, Ali; Schaub, Tim; Bailey, Steven H.; Myers, Simon; Brown, Spencer A.; Rohrich, Rod J.

doi:10.1097/prs.0b013e3181cb63e0

Cited by 152 publications

(92 citation statements)

References 17 publications

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“…Various factors can affect vascularization such as physiological situations, nervous, hormonal, and local factors. 17 The small number of specimens (10 cadavers, apropos 20 hemiabdomens, or DIEP flaps because we analyzed flap vascularization in the case when it was based on the right, and especially on the left DIEA) also limits our results because anatomic variation exists among patients. However, these studies give us useful information about the anatomical details and their variations, which can have great clinical significance.…”

Section: Discussionmentioning

confidence: 86%

“…The medial row perforators routinely cross the midline to perfuse the medial parts of the contralateral hemiabdominal wall and have more extensive branching and larger caliber vessels than lateral row perforators. [17][18][19][20][21] Analyzing the vascularization of the horizontal parts in zone I, we found the best vascularization in the middle 1/3 part. Also, we found the perforators with the largest diameter in this part (region 5).…”

Section: Discussionmentioning

confidence: 95%

“…When considering a lateral row-based perforator flap, vascularity was found to rarely cross the midline. 17 Recent studies have demonstrated dominance of the medial row perforators over the lateral row perforators. The medial row perforators routinely cross the midline to perfuse the medial parts of the contralateral hemiabdominal wall and have more extensive branching and larger caliber vessels than lateral row perforators.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Until recently, the Hartrampf perfusion zones were standard for selection of the DIEP flap tissue, but more recent studies show that the establishment of zoning is somewhat complex and contradictory. [17][18][19][20][21] We used the gelatin injection technique to define the vascular anatomy of the lower abdominal wall parts. Limitation of these cadaveric studies is inability to mimic physiological conditions, vasoconstriction and physiological shunting.…”

Section: Discussionmentioning

confidence: 99%

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Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

et al. 2011

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The objective of this study was to determine precise localization and external diameter of the lower abdominal wall perforators as well as to investigate some vascularity differences between the same parts of perfusion zones II and III according to Hartrampf perfusion zones. The study was performed on 10 fresh cadavers (20 hemiabdomens) using the gelatin injection technique. All perforators were identified, and their localization and diameter were noted. Measurements were made at the level of the fascia. We noted localization and diameter of arteries on cross-sectional planes of either part of the flap. The median sum of the external diameter of all arteries in zone I was 17.01 mm. The median sum of the external diameter of all arteries in the medial 1/3 part of zone III was 4.17 mm, and in the medial 1/3 part of zone II, it was 0.96 mm. The median sum of the external diameter of all arteries in the intermediary 1/3 part of zone III was 2.16 mm, whereas in the intermediary 1/3 part of zone II, it was 0.81 mm. Significant differences were recorded between proximal and middle horizontal regions of zones II and III and between medial vertical part of zone III and medial vertical part of zone II. Anastomoses between zones I and II are considerably smaller compared with anastomoses between zones I and III. The best vascularized parts of the lower abdominal wall were perfusion zone I, then the inner 2/3 of zone III and medial 1/3 of zone II.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

et al. 2011

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“…Because of numerous congenital and acquired anatomical variations of the DIEP branching pattern, thorough knowledge of the perforators topography and perforator dominance is essential for accurate preoperative planning. [3][4][5][6][7][8] The evolution of imaging technology has significantly contributed to the enhancement of predictability and reproducibility of DIEP breast reconstruction outcomes. Meticulous pre-operative imaging of the perforator flap and ISSN: 2320-5407 Int.…”

Section: Background:-mentioning

confidence: 99%

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Bahhati.¹,

Gravvanis²,

Karakitsos³

et al. 2017

IJAR

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Abdominal wall reconstruction

Townley

Höfer

2015

Plastic and Reconstructive Surgery

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The abdominal wall is a multilayered structure that wraps around and protects the abdominal viscera. In addition, it is involved in numerous other functions including trunk movement, respiratory effort (active expiration) and an adjunc tive force in micturition and defecation. Anatomically, it is bound by the xiphoid process and costal margin superiorly and the iliac crests and pubis inferiorly.The abdominal wall consists of skin, superficial fat, muscles, transversalis fascia and parietal peritoneum. Skin, subcutaneous fat and fasciaThe skin envelope of the abdomen is compliant and of intermediate thickness. Traditionally, two distinct layers of fascia are recognized -Camper's fascia and Scarpa's fascia. Camper's fascia represents the superficial layer, which contains variable amounts of fat. In males it is continuous with dartos fascia in the penis. Scarpa's fascia is deeper and more fibrous. It merges with the deep thigh fascia and superficial perineal fascia to contribute to fascia lata and Colles' fascia, respectively. In reality, it is more practical to think of three layers between the skin and abdominal musculature -superficial fat, membranous fascial layer (Scarpa's) and deep fat. The superficial fat layer is evenly distributed throughout the abdomen and the more vascular of the two. The deeper fat layer is of variable thickness, being thicker in the upper abdomen compared with the lower abdomen. 1

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Perforasomes of the DIEP Flap: Vascular Anatomy of the Lateral versus Medial Row Perforators and Clinical Implications

Abstract: Medial and lateral row perforators offer distinct and stereotypical zones of perfusion that have a significant effect on flap design and harvesting.

Cited by 152 publications

References 17 publications

Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Abdominal wall reconstruction

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