Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps

Background: This study uses three- and four-dimensional computed tomographic angiography and venography to evaluate the microvascular anatomy and perfusion of the deep inferior epigastric artery perforator (DIEP) and superficial inferior epigastric artery (SIEA) flaps. Methods: Ten DIEP flaps harvested from fresh cadavers and two abdominoplasty specimens were used. Studies of the largest single perforators from the medial and lateral rows were performed. Injections of the vena comitans of the perforators and of the superficial inferior epigastric veins were performed to evaluate venous drainage. Results: Zone IV was not perfused following injection of a lateral row perforator, whereas injection of a medial row perforator consistently resulted in perfusion of zone IV. Image analysis revealed the presence of large-diameter linking vessels at the level of the subdermal plexus between the perforators of the medial row, whereas lateral row perforators predominantly perfused the lateral aspect of the flap and perfused the medial row perforators by means of recurrent flow through the subdermal plexus. Medial row perforators perfused the flap in a central elliptical pattern, whereas lateral row perforators predominantly perfused the ipsilateral portion of the flap. The SIEA vessel branches were seen to course to the subdermal plexus and then to perfuse ipsilateral perforators through the subdermal plexus. Venous drainage occurred by means of the superficial inferior epigastric veins and the venae comitantes of the perforators. Conclusions: This study demonstrates that flow through medial and lateral row perforators occurs in physiologically stereotyped patterns. A medial row perforator should be selected if zone IV perfusion is required. The SIEA was consistently seen to only perfuse a hemiflap.