title: Suprascarpal fat pad thickness may predict venous drainage patterns in abdominal wall flaps.
abstract: BACKGROUND
  Abdominal wall flaps are routinely used in reconstructive procedures. In some patients inadequate venous drainage from the deep vein may cause fat necrosis or flap failure. Occasionally the superficial inferior epigastric vessels (SIEV) are of sufficient size to allow for microvascular revascularization. This study looked at the ratio of the sub- and suprascarpal fat layers, the number of deep system perforators, and SIEV diameter to determine any correlation of the fat topography and SIEV.
  
  
  METHODS
  50 abdominal/pelvic CT angiograms (100 hemiabdomens) were examined in women aged 34-70 years for number of perforators, SIEV diameter, and fat pad thickness above and below Scarpa's fascia. Data was analyzed using multivariate model.
  
  
  RESULTS
  The average suprascarpal and subscarpal layers were 18.6 ± 11.5 mm and 6.2 ± 7.2 mm thick, respectively. The average SIEV diameter was 2.06 ± 0.81 mm and the average number of perforators was 2.09 ± 1.03 per hemiabdomen. Hemiabdomens with suprascarpal thickness>23 mm had greater SIEV diameter [2.69 mm vs. 1.8 mm (P < 0.0001)] The fat layer thickness did not correlate with the number of perforators. Neither subscarpal fat thickness nor suprascarpal-to-subscarpal fat layer thickness correlated significantly with SIEV caliber or number of perforators in multivariate model.
  
  
  CONCLUSIONS
  Suprascarpal fat pad thicker than 23 mm had larger SIEVs irrespective of the number of deep system perforators. This may indicate a cohort of patients at risk of venous congestion from poor venous drainage if only the deep system is revascularized. We recommend harvesting the SIEV in patients with suprascarpal fat pad >23 mm to aid in superficial drainage.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College.
authors.forename: John
authors.initials: J
authors.lastname: Bast
authors.affiliation: Columbia University College of Physicians & Surgeons, New York, NY.
authors.forename: Austin A
authors.initials: AA
authors.lastname: Pitcher
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College.
authors.forename: Kevin
authors.initials: K
authors.lastname: Small
authors.affiliation: Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College.
authors.forename: David M
authors.initials: DM
authors.lastname: Otterburn
mesh_terms: D034861:Abdominal Wall / Q000033:anatomy & histology / Q000098:blood supply* / Q000000981:diagnostic imaging; D050154:Adiposity; D000328:Adult; D000368:Aged; D000072226:Computed Tomography Angiography; D019074:Epigastric Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D050507:Subcutaneous Fat, Abdominal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D013524:Surgical Flaps / Q000098:blood supply*