The originating pattern of deep inferior epigastric artery: anatomical study and surgical considerations
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Studies focusing on the originating patterns of the deep inferior epigastric artery (DIEA) have not been conducted. Here, we analyzed the vascular anatomy of the DIEA with computed tomographic angiography (CTA) to provide assistance during proximal pedicle dissection of a DIEA-based flap.
We conducted a retrospective study on patients who had undergone breast reconstruction with the transverse rectus abdominis musculocutaneous flap and the deep inferior epigastric perforator flap from March 2006 to October 2016. Preoperative three-dimensional computed tomographic angiograms of the abdominal wall (hemi-abdominal walls) were employed in this study, and three independent surgeons reviewed all CTA images. The originating angles and the distance from the originating point to the DIEA turning point were analyzed. Moreover, we assessed the relationship between the measured values and patients’ characteristics, such as abdominal surgery history.
CTA data of 184 patients and 368 hemiabdomens were reviewed and analyzed. Most of the DIEAs originated from the external iliac artery in the medial direction, proceeded caudally, and curved in a cephalic direction. The average descending length was 11.29 mm. As the DIEA origin angle decreased (toward the caudal direction), the distance of the initial descent increased (r = 0.382, p < 0.01). In addition, the descending length was significantly larger (p < 0.01) in the operation group (12.22 mm) than in the non-operation group (9.86 mm).
Surgeons should consider DIEA-originating patterns to ensure safe pedicle dissection during flap elevation.
KeywordsEpigastric arteries Rectus abdominis Reconstructive surgical procedures Free tissue flaps Angiography
This study was supported by Grant no. 02-2013-109 from the SNUBH (Seoul National University Bundang Hospital) Research Fund.
YM: Protocol development, data collection, manuscript writing. BC: Data collection, data analysis. SJY: Manuscript writing, illustration. BLY: Protocol development, manuscript writing. HK: Data collection, manuscript editing. CSP: Manuscript editing. CH: Protocol development, manuscript editing. JHJ: Protocol development, data collection, manuscript writing.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of the Committee on Clinical Investigation of Seoul National University Bundang Hospital (B-1702-382-105).
All patients provided written consent for the use of their photographs.
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