title: Paramuscular perforators in DIEAP flap for breast reconstruction.
abstract: One of the main steps in perforator flap surgery is to identify the dominant perforator. Using multidetector row computed tomography (MDCT) for the preoperative planning of deep inferior epigastric artery perforator (DIEAP) flap surgery, we identified a perforator with a large caliber, an excellent location in the middle abdominal region, and a totally extramuscular trajectory in a significant number of patients. We describe the frequency of this perforator and determine its characteristics.
  
  
  METHODS
  We conducted a retrospective study of 482 patients who underwent 526 DIEAP flaps for breast reconstruction from October 2003 to October 2011. Mean age at surgery was 51.3 years old. A preoperative MDCT of abdominal vascularization was performed in all patients.
  
  
  RESULTS
  MDCT identified a dominant perforator with a paramuscular course in 12.4% of abdominal walls. In all cases, it was located in the midline and emerged directly from the deep inferior epigastric system. Its mean caliber was 1.9 mm. The flap was harvested based on this perforator in all these patients, and mean harvest time was 51 minutes. The characteristics of this perforator made dissection easier and reduced morbidity at the donor site. There were no flap losses and the only complications were minor.
  
  
  CONCLUSIONS
  We located a paramuscular perforator in 12.4% of patients undergoing breast reconstruction with abdominal perforator flaps. Its morphological features and extramuscular course make it the perforator of choice in DIEAP flap surgery.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Hospital de la Santa, Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona; and †Radiology Department, Clinica Creu Blanca, Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pons
authors.forename: Jaume
authors.initials: J
authors.lastname: Masia
authors.forename: Lídia
authors.initials: L
authors.lastname: Sanchez-Porro
authors.forename: Jose
authors.initials: J
authors.lastname: Larrañaga
authors.forename: Juan Angel
authors.initials: JA
authors.lastname: Clavero
mesh_terms: D000328:Adult; D000368:Aged; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies