title: Vascular anatomy of the deep inferior epigastric artery perforator flap: a systematic review.
abstract: BACKGROUND
  The deep inferior epigastric artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap.
  
  
  METHODS
  The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy.
  
  
  RESULTS
  The perforators originating from the deep inferior epigastric artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course (<4 cm) is most common (61 to 80 percent), followed by a long intramuscular course (>4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection.
  
  
  CONCLUSIONS
  The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.
authors.affiliation: Dallas, Texas; Washington, D.C.; and Rochester, Minn. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Department of Plastic Surgery, Georgetown University Medical Center; and the Division of Plastic and Reconstructive Surgery, Mayo Clinic.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Ireton
authors.forename: Chrisovalantis
authors.initials: C
authors.lastname: Lakhiani
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
mesh_terms: D019074:Epigastric Arteries / Q000033:anatomy & histology* / Q000637:transplantation; D005260:Female; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D016462:Mammaplasty / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D016896:Treatment Outcome