An anatomic study of deep inferior epigastric artery diameters at the origin from external iliac and at the lateral border of rectus abdominis muscle by computed tomographic angiography from autologous breast reconstruction patients

Background. - Autologous breast reconstruction by means of microsurgical abdominal flaps is an very well described technique. The flap harvest dissection under inguinal ligament would cause the risk of parietal weakening in this zone and postoperative bulging. The goal of our study is to investigate whether the deep inferior epigastric artery diameter remains constant from its exit of the external iliac artery to its entrance in the rectus muscle sheath. Patients and method. - One hundred arteries were studied on fifty preoperative computed tomographic angiographies made before a DIEAP flap for breast reconstruction. We measured the caliber of the left and right deep inferior epigastric arteries at these two landmarks. The length of this artery between these was also calculated. This data were collected with specific angiography reconstruction. Results. - At the caudal landmark, the mean DIEA diameter was 2.1 +/- 0.27 mm on the left side and 2.1 +/- 0.31 mm on the right side. At the cephalic landmark, the mean DIEA diameter was 2.0 +/- 0.28 mm on the left and 2.0 +/- 0.27 mm on the right side (P = 0.00035 at left side; P = 0.0089 at right side). The mean pedicle length between the two landmarks was 22.3 +/- 2.85 mm on the left side and 22.2 +/- 2.98 mm on the right side. Conclusion. - This computed tomographic angiography study showed that the diameter of DIEA is equivalent at its origin and at the lateral border of muscle. Flap harvest without dissection under inguinal ligament provides sufficient pedicle length and caliber to allow for comfortable and reliable sutures. (C) 2019 Elsevier Masson SAS. All rights reserved.