title: Delaying the superficial inferior epigastric artery flap: a solution to the problem of the small calibre of the donor artery.
abstract: BACKGROUND
  Superficial inferior epigastric artery (SIEA) flap has a great advantage over other flaps of the area, that is, readily non-existent donor-site problems. The main reason why the SIEA flap has never been extensively used in breast reconstruction is the small diameter and variable anatomy of its donor artery. This study presents a possibility of enlarging the SIEA diameter using the delay-phenomenon mechanism.
  
  
  METHODS
  A prospective clinical study of 26 patients was undertaken. Prior to surgery, ultrasound examinations were performed, measuring the diameter of SIEA and the velocity of blood flow in SIEA. The ipsilateral deep inferior epigastric artery (DIEA) was then ligated in all patients who had a measurable SIEA preoperatively. Two weeks later, measurements were repeated. The blood flow through SIEA was calculated and statistical analysis was applied.
  
  
  RESULTS
  Twenty-one patients had an identifiable SIEA on preoperative measurements. On postoperative measurements, we confirmed ligation of DIEA in 19 patients, of these 17 patients had an augmentation in diameter (mean: 29%) and 18 in blood flow (mean: 127%).
  
  
  CONCLUSIONS
  This study shows that ligating a single of the three main arteries (DIEA, SIEA and superficial circumflex iliac artery) irrigating skin/soft tissue of the lower abdomen, although the dominant one, results in widening of diameter and enlarging of blood flow of another artery (SIEA) supplying the same angiosome. The results of the present study might be used in future to increase the diameter and flow in SIEA when the vessel diameter found on preoperative imaging was too small for clinical microsurgical transfer. The drawback of the proposed delay procedure is the sacrifice of ipsilateral DIEA and an added operative procedure. STATEMENT: The clinical trial is registered with Clinical Trials (http://www.clinicaltrials.gov/). The clinical trial registration number is NCT01247129.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Medical Centre Maribor, Maribor, Slovenia. minja.gregoric@gmail.com
authors.forename: Minja
authors.initials: M
authors.lastname: Gregorič
authors.forename: Vojko
authors.initials: V
authors.lastname: Flis
authors.forename: Franko
authors.initials: F
authors.lastname: Milotić
authors.forename: Božidar
authors.initials: B
authors.lastname: Mrđa
authors.forename: Barbara
authors.initials: B
authors.lastname: Stirn
authors.forename: Zoran M
authors.initials: ZM
authors.lastname: Arnež
mesh_terms: D001783:Blood Flow Velocity; D019074:Epigastric Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008026:Ligation; D008297:Male; D008866:Microsurgery; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014648:Varicose Veins / Q000601:surgery