The first two authors contributed equally to this work.
The perforator angiosome: A new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstruction
Article first published online: 6 JUL 2009
Copyright © 2009 Wiley-Liss, Inc.
Volume 30, Issue 1, pages 1–7, January 2010
How to Cite
Rozen, W. M., Ashton, M. W., Le Roux, C. M., Pan, W.-R. and Corlett, R. J. (2010), The perforator angiosome: A new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstruction. Microsurgery, 30: 1–7. doi: 10.1002/micr.20684
- Issue published online: 5 JAN 2010
- Article first published online: 6 JUL 2009
- Manuscript Accepted: 21 MAY 2009
- Manuscript Received: 11 MAR 2009
Background: The previously described “perfusion zones” of the abdominal wall vasculature are based on filling of the deep inferior epigastric artery (DIEA) and all its branches simultaneously. With the advent of the DIEA perforator flap, only a single or several perforators are included in supply to the flap. As such, a new model for abdominal wall perfusion has become necessary. The concept of a “perforator angiosome” is thus explored. Methods: A clinical and cadaveric study of 155 abdominal walls was undertaken. This comprised the use of 10 whole, unembalmed cadaveric abdominal walls for angiographic studies, and 145 abdominal wall computed tomographic angiograms (CTAs) in patients undergoing preoperative imaging of the abdominal wall vasculature. The evaluation of the subcutaneous branching pattern and zone of perfusion of individual DIEA perforators was explored, particularly exploring differences between medial and lateral row perforators. Results: Fundamental differences exist between medial row and lateral row perforators, with medial row perforators larger (1.3 mm vs. 1 mm) and more likely to ramify in the subcutaneous fat toward the contralateral hemiabdomen (98% of cases vs. 2% of cases). A model for the perfusion of the abdominal wall based on a single perforator is presented. Conclusion: The “perforator angiosome” is dependent on perforator location, and can mapped individually with the use of preoperative imaging. © 2009 Wiley-Liss, Inc. Microsurgery, 2010.