title: The short- and ultrashort-pedicle deep inferior epigastric artery perforator flap in breast reconstruction.
abstract: BACKGROUND
  Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is becoming more common and can help reduce donor site morbidity. The authors proposed that dissection of the deep inferior epigastric artery (DIEA) and vein (DIEV) to their external iliac source may not be required for safe flap transfer.
  
  
  METHODS
  Sixteen whole fresh cadaveric hemiabdomens were used to dissect transverse abdominal-based flaps. Latex injection of the DIEA system was carried out, and the diameters of the DIEA/DIEV vessels were assessed at various points along the course of the pedicle from the origin to the perforator. A clinical study of 26 patients who underwent a short and ultrashort pedicle DIEP flaps was carried out.
  
  
  RESULTS
  The average DIEA and DIEV vessel diameters were relatively similar from the external iliac origin to a point just caudal to the bifurcation. At the lateral rectus edge, the average DIEA diameter was 3.2 mm, and the DIEV diameter was 3.1 mm. The average pedicle length obtained with classic DIEP dissection was 16.9 cm, short-pedicle DIEP dissection 10.4 cm, ultrashort technique 8.1 cm, and free TRAM technique 6.5 cm. Venous injection study demonstrated rich venous interconnections between both venae comitantes. In their clinical study, the authors were able to achieve average pedicle lengths of 11.0 cm when transecting cranial to the lateral edge of the rectus, with average diameters of 2.5 mm (artery) and 2.9 mm (vein).
  
  
  CONCLUSIONS
  Transection of the DIEA/DIEV pedicle at the lateral rectus edge or more proximally is safe and can help reduce operative time and donor-site morbidity.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas.
authors.forename: Shannon
authors.initials: S
authors.lastname: Colohan
authors.forename: Munique
authors.initials: M
authors.lastname: Maia
authors.forename: Claude Jean
authors.initials: CJ
authors.lastname: Langevin
authors.forename: Andrea
authors.initials: A
authors.lastname: Donfrancesco
authors.forename: Arash
authors.initials: A
authors.lastname: Shirvani
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Trussler
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*