title: Peritoneo-cutaneous perforators in deep inferior epigastric perforator flaps: a cadaveric dissection and computed tomographic angiography study.
abstract: BACKGROUND
  Cutaneous perforators that do not originate from the deep inferior epigastric artery (DIEA) are rare, but may significantly affect operative outcome. Peritoneal-cutaneous perforators have been described as a source for augmenting the blood flow to a deep inferior epigastric perforator (DIEP) flap, however if unrecognized, may compromise flap survival.
  
  
  METHODS
  We reviewed 375 DIEA perforator (DIEP) flaps (325 with preoperative CTA and 50 cadaveric dissections) to investigate the incidence of this anomaly.
  
  
  RESULTS
  We detected this variation in 3/325 (1%) of DIEP flaps following preoperative computed tomography. In 1/50 (2%) of the cadaveric specimens, a peritoneal-cutaneous perforator was found and injected with lead oxide contrast. It was shown to fill the cutaneous veins of the majority of the lower abdominal integument.
  
  
  CONCLUSIONS
  Peritoneal-cutaneous perforators are rare anatomical variations (4/375: 1.1%) that may have significant ramifications for surgery utilizing the vasculature of the abdominal wall. CTA was significantly able to detect this anomaly and aid operative planning. Preoperative CTA helps to safely identify individual vascular anatomy including rare variations.
authors.affiliation: Department of Plastic, Reconstructive and Burns Surgery, Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Morriston, Swansea, United Kingdom.
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Smit
authors.forename: Angeliki
authors.initials: A
authors.lastname: Dimopoulou
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002102:Cadaver; D004210:Dissection; D019074:Epigastric Arteries / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016462:Mammaplasty; D008866:Microsurgery; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods