title: Pedicled thinned deep inferior epigastric artery perforator flap for perineal reconstruction: a preliminary report.
abstract: BACKGROUND
  Deep inferior epigastric artery perforator (DIEP) flap has proved to be an effective method in perineal reconstruction. However, a few literatures have reported thinned DIEP flap which yields a better functional and cosmetic result. There are also no clear guidelines on the degree to which a DIEP flap may be debulked of excess tissue before flap viability becomes compromised. In this preliminary report, a series of patients are presented whereby perineal reconstruction was achieved using the pedicled, thinned DIEP flap, based on debulking parameters from our clinical findings.
  
  
  METHODS
  Between September 2007 and August 2010, 12 pedicled, thinned DIEP island flaps for perineal reconstruction were performed on three patients with vulval or vaginal tumour, five patients with congenital vaginal agenesis and four patients with perineal Paget's disease. The flap was thinned in the plane inferior to the superficial inferior epigastric vein based on the subcutaneous vasculature of the abdominal wall, as depicted by preoperative computed tomography (CT) angiography (CTA) examination.
  
  
  RESULTS
  Preoperative abdominal CTA can perfectly display the anatomy of DIEP flap. With a sensitivity of 100% and a specificity of 100% (Φ>0.5 mm), it helped in reducing the harvesting time for the flap and in guiding flap thinning. Partial necrosis of the distal flap occurred in a relatively large transverse flap measuring 24 cm×8.5 cm. One patient experienced dehiscence and a subsequent suture was successfully made. The other ten flaps were transplanted successfully without any complications.
  
  
  CONCLUSIONS
  This series demonstrates that DIEP flap can be reliably debulked in the plane inferior to the superficial inferior epigastric vein with relatively no risk of necrosis and can be used safely in perineal reconstruction. The abdominal CTA can be employed as an assisting tool to plan the DIEP flap as well as guide flap thinning.
authors.affiliation: Department of Plastic Surgery, Second Xiangya hospital, Central South Universtiy, Changsha, Hunan, China.
authors.forename: Bai-rong
authors.initials: BR
authors.lastname: Fang
authors.forename: Hurbungs
authors.initials: H
authors.lastname: Ameet
authors.forename: Xiao-fang
authors.initials: XF
authors.lastname: Li
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.forename: Xian-cheng
authors.initials: XC
authors.lastname: Wang
authors.forename: Ang
authors.initials: A
authors.lastname: Zeng
authors.forename: Qun
authors.initials: Q
authors.lastname: Qiao
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014621:Vagina / Q000002:abnormalities*; D014625:Vaginal Neoplasms / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000601:surgery*; D055815:Young Adult