Summary
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.
Aim
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.
Study design
Clinical, prospective study in a university-affiliated department of plastic surgery.
Patients
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.
Results
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).
Conclusion
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.
Keywords
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References
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Article info
Publication history
Published online: November 20, 2006
Accepted:
December 8,
2005
Received:
March 28,
2005
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
