Reviewing the vascular supply of the anterior abdominal wall: Redefining anatomy for increasingly refined surgery

Abstract

The abdominal wall integument is becoming the standard donor tissue for postmastectomy breast reconstruction, with its vascular supply of key importance to the reconstructive surgeon. Refinements in tissue transfer, from pedicled to free flaps and musculocutaneous to perforator flaps, have required increasing understanding of finer levels of this vascular anatomy. The widespread utilization of the deep inferior epigastric artery (DIEA) perforator flap, particularly for breast reconstruction, has rekindled clinical interest in further levels of anatomical detail, in particular the location and course of the musculocutaneous perforators of the DIEA. Advances in operative techniques, and anatomical and imaging technologies, have facilitated an increase in this understanding. The current review comprises an appraisal of both the anatomical and clinical literature, with a view to highlighting the key anatomical features of the abdominal wall vasculature as related to reconstructive flaps.

Endoscopic abdominoplasty providing a perforator fat flap for treatment of hemi-facial microsomia

“…The deep inferior epigastric artery (DIEA) perforator flap is wellknown in reconstructive surgery (Garusi et al, 2010, Rozen et al, 2008. This is the first reported case, where the standard free flap was modified as a fat flap only.…”

Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforators

“…Not only does an abdominal wall CTA display the DIEA and its branches, but it also displays other vessels supplying the abdominal wall, namely the SIEA, SSEA, deep superior epigastric artery (DSEA), deep circumflex iliac artery, superficial circumflex iliac artery, posterior intercostal arteries, and lumbar arteries. 18 The superior and inferior gluteal arteries are also displayed. In addition, the soft tissues of the abdominal wall and indeed the abdominal contents are also included within the scan data.…”

Unusual Complication After Left-Lobe Liver Biopsy for Diffuse Liver Disease: Severe Bleeding From the Superior Epigastric Artery

“…Superior epigastric artery bleeding [19] has been extensively discussed in the surgical literature with regard to the placement of laparoscopy ports. It is also well recognized in the plastic surgery literature.…”