Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction.

ABSTRACT

OBJECTIVE: To find out the most suitable perforator and cutaneous nerve for strategic design of the deep inferior epigastric perforator (DIEP) flap. MATERIAL AND METHOD: The characteristics of the pedicles, perforators, intercostal nerves and the relationship between nerves and vessels in DIEP flaps were studied in 31 formalin-preserved cadavers. RESULTS: Four hundred and five perforator vessels were divided into three vertical rows. These perforators were mostly contained in the medial row (45.4%), the average size of the perforators in the lateral row was the largest (1.0+/- 0.3 mm). The largest perforators (1.4+/- 0.3 mm) were mostly located within 1 cm horizontally from the umbilicus. Lateral row perforators, usually rectilinear course (82.7%), traveled with nerves from the beginning. Whereas, the perforators in the medial row usually coursed obliquely (86.4%) and were not related to nerves initially, they joined before piercing the rectus sheath. CONCLUSION: The present findings indicate that it would be more beneficial to use the lateral row perforators.