title: A combined anatomical and clinical study for quantitative analysis of the microcirculation in the classic perfusion zones of the deep inferior epigastric artery perforator flap.
abstract: BACKGROUND
  The establishment of the perfusion zones for the deep inferior epigastric artery perforator (DIEP) flap is still under debate. Specifically, differences between clinical and anatomical studies have often been described. The purpose of this combined study was to evaluate the characteristics of a DIEP zoning in both clinical and anatomical settings by quantitatively assessing the perfusion dynamics and vascular anatomy.
  
  
  METHODS
  In the first part of the study, the perfusion dynamics of 16 patients undergoing DIEP flap breast reconstruction were assessed, determining cutaneous oxygen supply and blood flow using an Oxygen to See device. In the second part of the study, 11 flaps were harvested from fresh female cadavers. All specimens were subjected to dynamic computed tomographic scanning to simulate single-perforator DIEP flaps.
  
  
  RESULTS
  The perfusion dynamics of DIEP flaps show no significant difference (p ≤ 0.05) between the two immediately adjacent zones, regardless of the use of lateral or medial perforator rows. However, use of the cadaver medial row perforator more often illustrated a vascular pattern across the midline (zone II, 86.4 percent) as compared with the lateral row-perfused DIEP flap.
  
  
  CONCLUSIONS
  The authors' combined study showed varying perfusion characteristics between anatomical and clinical settings, which could be caused by a number of complex systemic and local processes. Thus, the selection of the DIEP zones should be assessed individually depending on the anatomy in question and the characteristics of the perforators until the mentioned issues are clarified in detail.
authors.affiliation: Tübingen, Germany From the Departments of Plastic, Reconstructive, Hand, and Burn Surgery and Diagnostic and Interventional Radiology, BG-Trauma Center, and the Institute of Anatomy, Eberhard Karls University Tübingen.
authors.forename: Afshin
authors.initials: A
authors.lastname: Rahmanian-Schwarz
authors.forename: Jens
authors.initials: J
authors.lastname: Rothenberger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hirt
authors.forename: Oliver
authors.initials: O
authors.lastname: Luz
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
mesh_terms: D000005:Abdomen / Q000098:blood supply; D000328:Adult; D019074:Epigastric Arteries; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010101:Oxygen Consumption; D013524:Surgical Flaps / Q000098:blood supply*
chemical_list: D006454:Hemoglobins