Paramuscular and paraneural perforators in DIEAP flaps: radiographic findings and clinical application.
The computed tomography microangiography revolutionized the planning of abdominal flaps, and enabled us to identify perforators from the deep inferior epigastric system with a medial extramuscular or minimal medial intramuscular trajectory. We define these perforators as paramuscular and paraneural, since their main course is retromuscular and they emerge medial to the medial border of rectus muscle or medial to its motor nerve supply, respectively. Studying the different perforator distributions in the abdomen of 58 patients who underwent breast reconstruction with deep inferior epigastric artery perforator flap, we have recorded that 46.4% of the abdominal walls have a dominant paramuscular/paraneural perforator (25.8% paramuscular and 20.6% paraneural) with an average diameter 1.56 +/- 0.2 mm. Although, the comparison of the rectus muscle morbidity following deep inferior epigastric artery perforator flap dissection based on paramuscular/paraneural and based on other perforator patterns, did not reveal significant differences, paraneural/paramuscular type perforators are not related anatomically to the motor nerves, and the donor site morbidity should be negligible in any operator's hands.
Gravvanis
Andreas
A
Department of Plastic Surgery, Queen Victoria Hospital, Foundation Trust, NHS, West Sussex, United Kingdom. gravvani@yahoo.com
Dionyssiou
Dimitris D
DD
Chandrasekharan
Lekha
L
Francis
Ian
I
Smith
Roger W
RW
D034861:Abdominal Wall / Q000098:blood supply*; D000792:Angiography / Q000379:methods; D004210:Dissection; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D017568:Rectus Abdominis / Q000098:blood supply / Q000294:innervation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed