Following the TRAM and the DIEP the SIEA flap is the next logical step to reduce the donor site morbidity in autologous breast reconstruction. The vascular axis of the SIEA flap, however, is completely different from the deep epigastric pedicle, on which previous lower abdominal flaps were based. Therefore, a mapping of the vascular territory, which can be reliably harvested on this pedicle, seems mandatory before this new technique can become established.
To chart the angiosome of the superficial inferior epigastric artery with regard to breast reconstruction and to evaluate the random extension of the vascular territory, which can be reliably raised on this pedicle.
Clinical, prospective study in a university-affiliated department of plastic surgery.
Ten patients undergoing autologous breast reconstruction with the superficial inferior epigastric perforator flap and five patients undergoing aesthetic abdominoplasty with isolation of the abdominal flap on the superficial epigastric vessels.
Material and methods
After isolation of the abdominal panniculus on a single superficial inferior epigastric artery pedicle, the flap was divided in the four conventional zones according to Hartrampf. Perfusion in each of the four zones was measured on the table using the technique of dynamic laser-fluorescence videoangiography.
Perfusion of Hartrampf Zone III occurred first (25 s post-injection) and the perfusion index amounted median 89% of reference. Perfusion of Zone I occurred median 5 s later and the relative perfusion was 80%. Perfusion of the contralateral zones II and IV was dramatically reduced to 8% and zero, respectively, and this reduction was statistically significant (p<0.0001).
The true angiosome of the superficial epigastric artery is located laterally on the ipsilateral hemiabdomen. Its random extension is unreliable and ranges most frequently only to the midline. Based on the results of this study, survival of the skin and subcutaneous fat taken laterally to the border of the contralateral rectus sheath seems questionable. Therefore, the versatility of the SIEA flap for autologous breast reconstruction seems limited when compared with the conventional methods based on the deep inferior epigastric system.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The free abdominoplasty flap and its use in breast reconstruction.Scand J Plast Reconstr Surg. 1979; 13: 423-427
- Breast reconstruction with a transverse abdominal island flap.Plast Reconstr Surg. 1982; 69: 216-225
- Inferior epigastric artery skin flaps without rectus abdominis muscle.Br J Plast Surg. 1989; 42: 645-648
- The free abdominoplasty flap for immediate breast reconstruction.Ann Plast Surg. 1991; 27: 351-354
- Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery.Plast Reconstr Surg. 1984; 74: 657-670
- The vascular territories of the superior epigastric and the deep inferior epigastric systems.Plast Reconstr Surg. 1984; 73: 1-16
- Venous congestion and blood flow in free transverse rectus abdominis and deep inferior epigastric perforator flaps.Plast Reconstr Surg. 2000; 106: 1295-1299
- Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap.Br J Plast Surg. 2000; 53: 205-208
- The versatile deep inferior epigastric (inferior rectus abdominis) flap.Br J Plast Surg. 1984; 37: 330-350
- The versatile superficial inferior epigastric flap for breast reconstruction.Ann Plast Surg. 1994; 32: 113-117
- Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap.Br J Plast Surg. 1999; 52: 276-279
- Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps.Plast Reconstr Surg. 2004; 114: 1077-1083
- The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system.Plast Reconstr Surg. 1988; 82: 815
- Perfusion zones of the DIEP flap revisited: a clinical Study.Plast Reconstr Surg. 2006; 117: 37-43
- The vascular territories (angiosomes) of the body: experimental study and clinical applications.Br J Plast Surg. 1987; 40: 113-141
- TRAM and DIEP flap zones.Br J Plast Surg. 2001; 54 ([short correspondence]): 272-280
- Ex vivo intraoperative angiography for rectus abdominis musculocutaneous free flaps.Plast Reconstr Surg. 2002; 109: 2247
Published online: November 20, 2006
Accepted: December 8, 2005
Received: March 28, 2005
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.