The perforator angiosome: a new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstruction.
BACKGROUND
The previously described "perfusion zones" of the abdominal wall vasculature are based on filling of the deep inferior epigastric artery (DIEA) and all its branches simultaneously. With the advent of the DIEA perforator flap, only a single or several perforators are included in supply to the flap. As such, a new model for abdominal wall perfusion has become necessary. The concept of a "perforator angiosome" is thus explored.


METHODS
A clinical and cadaveric study of 155 abdominal walls was undertaken. This comprised the use of 10 whole, unembalmed cadaveric abdominal walls for angiographic studies, and 145 abdominal wall computed tomographic angiograms (CTAs) in patients undergoing preoperative imaging of the abdominal wall vasculature. The evaluation of the subcutaneous branching pattern and zone of perfusion of individual DIEA perforators was explored, particularly exploring differences between medial and lateral row perforators.


RESULTS
Fundamental differences exist between medial row and lateral row perforators, with medial row perforators larger (1.3 mm vs. 1 mm) and more likely to ramify in the subcutaneous fat toward the contralateral hemiabdomen (98% of cases vs. 2% of cases). A model for the perfusion of the abdominal wall based on a single perforator is presented.


CONCLUSIONS
The "perforator angiosome" is dependent on perforator location, and can mapped individually with the use of preoperative imaging.
Rozen
Warren M
WM
Department of Anatomy and Cell Biology, The University of Melbourne, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Parkville, Victoria, 3050, Australia. warrenrozen@hotmail.com
Ashton
Mark W
MW
Le Roux
Cara Michelle
CM
Pan
Wei-Ren
WR
Corlett
Russell J
RJ
D050153:Abdominal Fat / Q000098:blood supply / Q000000981:diagnostic imaging; D000009:Abdominal Muscles / Q000098:blood supply / Q000000981:diagnostic imaging; D034861:Abdominal Wall / Q000098:blood supply* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002102:Cadaver; D015331:Cohort Studies; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D008297:Male; D016462:Mammaplasty; D008833:Microcirculation; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed