title: Needing a large DIEAP flap for unilateral breast reconstruction: double-pedicle flap and unipedicle flap with additional venous discharge.
abstract: BACKGROUND
  In selected cases a four zone-deep inferior epigastric artery perfortor (DIEAP) flap is needed for unilateral breast reconstruction. It may happen in patients with a midline scar of the abdomen or with minimal abdominal tissue, as well as in case the recipient site needs a big amount of tissue for the breast reconstruction. The purpose of this paper is to describe two options: to raise an unipedicle DIEAP flap including large size medially located perforator/s with an additional venous outflow, or to raise a double-pedicle DIEAP flap.
  
  
  METHODS
  Since 2000 34 cases of unilateral breast reconstruction with a four-zone unipedicle DIEAP flap (two cases) or a double-pedicle DIEAP flap (32 cases) have been performed. Preoperative examination of the superficial and deep epigastric vascular system with color doppler sonography (CDS) and/or multidetector-row CT (MDCT) were performed to assess the dominant abdominal perforator/s. If one or two large size, medially located perforators were identified and the superficial venous system showed vascular connections between right and left hemiabdomen, it was possible to use an unipedicle four-zone DIEAP flap with an additional anastomosis of the superficial vein. If this specific vascular situation did not exist, a double-pedicle DIEAP flap was raised.
  
  
  RESULTS
  There were no major complications, and very satisfactory results have been obtained.
  
  
  CONCLUSIONS
  This retrospective study showed that both options of raising a large DIEAP flap for unilateral breast reconstruction, namely unipedicled flap based on large medial perforator/s plus additional venous discharge or double-pedicle flap, are safe. Preoperative examination of the dominant perforator/s with CDS and/or MDCT is mandatory in both cases.
authors.affiliation: Department of Plastic Surgery, Catholic University of Sacred Hearth, Rome, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Salgarello
authors.forename: Liliana
authors.initials: L
authors.lastname: Barone-Adesi
authors.forename: Marcella
authors.initials: M
authors.lastname: Sturla
authors.forename: Riccardo
authors.initials: R
authors.lastname: Masetti
authors.forename: Lanhua
authors.initials: L
authors.lastname: Mu
mesh_terms: D034861:Abdominal Wall / Q000098:blood supply / Q000473:pathology; D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004210:Dissection; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome