The “Circummuscular” Free TRAM Pedicle

Godfrey, Philip M.; Godfrey, Norman V.; Romita, Mauro C.

doi:10.1097/00006534-199401000-00029

Cited by 19 publications

(6 citation statements)

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“…Such variations include an anomalous origin of the DIEA, which while usually arising from the external iliac artery, has been described as arising from the obturator artery (Jakubowicz and Czarniawska-Grzesiñska, 1996;Kawai et al, 2008) or the femoral artery (Jakubowicz and Czarniawska-Grzesiñska, 1996). The course of the artery has similarly been described with rare variations, in which a circum-muscular course (Godfrey et al, 1994;Hill and Millar, 1997;Yano et al, 2003;Heo et al, 2008;Rozen et al, 2009b), or paramuscular course (Rozen et al, 2009b,e), each avoids any intramuscular pathway. Although all of these variations are rare, the importance for a particular patient in such cases, particularly an absent DIEA, is substantial.…”

Section: Discussionmentioning

confidence: 99%

The branching pattern of the deep inferior epigastric artery revisited in‐vivo: A new classification based on CT angiography

2009

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The deep inferior epigastric artery (DIEA) is a reliable pedicle in the design of DIEA perforator flaps, with variations in its anatomy infrequent. Previous studies describing its branching pattern have all been based on cadaveric anatomy and described the following three branching patterns: Type 1 (single trunk), Type 2 (bifurcating trunk), and Type 3 (trifurcating trunk). The increased use of preoperative imaging, particularly with computed tomographic angiography (CTA), has enabled visualization of the DIEA and its branches in vivo, providing a functional view of this anatomy. We undertook a study of 250 patients (500 hemiabdominal walls) undergoing preoperative CTA before DIEA perforator flaps for breast reconstruction. The branching pattern of the DIEA and correlation to the contralateral hemiabdominal wall were assessed. The branching patterns of the DIEA were found to be different in vivo compared with cadaveric studies, with a higher than previously reported incidence of Type 1 patterns and lower than reported incidence of Type 3 patterns, and that some patterns exist which were not included within the previous nomenclature (namely, Type 0 or absent DIEA and Type 4 or four-trunk DIEA). There was also shown to be no overall concordance in the branching patterns of the DIEA between contralateral sides of the same abdominal wall; however, there was shown to be a statistically significant concordance in cases of a Type 1 DIEA (51% concordance, P = 0.04). As such, a new modification to the classification system for the branching pattern of the DIEA is presented based on imaging findings.

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Section: Discussionmentioning

confidence: 99%

The branching pattern of the deep inferior epigastric artery revisited in‐vivo: A new classification based on CT angiography

2009

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“…18 The course of the artery has similarly been described with the rare variation of a circummuscular course, avoiding any intramuscular pathway. 19,20 Yano et al went on to describe this variant with the use of preoperative color duplex imaging, 21 and Heo et al described this anomaly with the use of preoperative CTA. 22 With the use of preoperative CTA, we describe a unique case of a completely absent DIEA in patient who had not previously undergone any open abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

The Absent Inferior Epigastric Artery: A Unique Anomaly and Implications for Deep Inferior Epigastric Artery Perforator Flaps

Rozen

Houseman²,

Ashton³

2009

J reconstr Microsurg

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The abdominal wall is particularly advantageous as a donor site due to the reliability of its vascular supply. Although the cutaneous perforators of the deep inferior epigastric artery (DIEA) and the superficial inferior epigastric artery (SIEA) may show significant individual variability, the DIEA itself has been shown to be ever-present as a vascular pedicle and to be highly dependable. The increasing use of preoperative computed tomographic angiography (CTA) has led to increasing reports of anatomic variability. With the use of preoperative CTA, we describe a unique case of a completely absent DIEA in patient who had not previously undergone any open abdominal surgery. The absence of the DIEA had led to vascular changes throughout the abdominal wall, including dilatation of both SIEAs and the ipsilateral deep superior epigastric artery. Preoperative CTA in this setting helped us identify this anomaly and aided surgical planning. The incidence of this anomaly was subsequently reviewed in 150 consecutive CTA scans performed at our institution.

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“…This vascular anatomic consistency gives the RAM flap a great advantage as a local and free transfer. To our knowledge only three cases of anomalous DIEA 6,7 have been reported so far. Two of them were encountered by Godfrey et al 6 in establishing the free transverse RAM flap.…”

Section: Discussionmentioning

confidence: 97%