Deep Inferior Epigastric Artery Perforator Flap

Abstract

The first report of flap raising procedures at the anterior abdominal wall including parts of the rectus muscle was given by Brown et al., who described the myocutaneous rectus abdominis flap as a pedicled flap [47]. This report was followed by the first microvascular transfer with anastomoses to the deep inferior epigastric vessels performed by Pennington and Pelly [292]. Before this, the significance of the perforating vessels of the rectus muscle was emphasized by Holstrom (1979) and Robbins (1979). The superficial epigastric vascular system was already used as a source for free skin flaps raised from the lower abdomen and groin region by Antia and Buch (1971) [11] and Taylor and Daniel (1975) [381]. Both the deep and the superficial systems have partially overlapping vascular territories and are connected by choke arteries. Of these, the paraumbilical perforators originating from the deep system are the strongest and therefore contribute most to skin perfusion of the anterior abdominal wall [33, 46, 116]. Very soon after the first descriptions, a number of different flap designs and orientations of the skin paddle were described, all confirming the unique usefulness of myocutaneous flaps from the deep inferior vascular system. The main indication for this conventional myocutaneous flap, which includes significant parts of the rectus abdominis muscle, is breast reconstruction, but it is also used for other regions of the body such as the skull base, face, head and neck, trunk, and extremities [48, 95, 97, 143, 264, 384, 402, 404, 438].