title: Mapping the superficial inferior epigastric system and its connection to the deep system: An MRA analysis.
abstract: The superficial inferior epigastric vasculature plays a critical role in free abdominal tissue transfer. However, its anatomic variations are incompletely characterized. An investigation was conducted on the preoperative imaging of patients undergoing free-flap breast reconstruction by a single surgeon between 2008 and 2013. This study included patients who underwent abdominal magnetic resonance angiogram (MRA). A coordinate system was used to draw the main trunk and primary branches from each patient's superficial inferior epigastric system. Each hemiabdomen's branching pattern was categorized as simple, complex, or absent. The number of superficial-to-deep inferior epigastric connections and the presence or absence of a superficial system crossing the midline were recorded. Interrater reliability was assessed for two raters. This analysis included 53 patients (106 hemiabdomens). A total of 80 (75%) hemiabdomens were categorized as having simple and 10 (9%) as complex branching patterns. A total of 16 (15%) hemiabdomens had no identifiable vessels. At least one superficial-to-deep connection was found among 89 hemiabdomens (84%). Superficial systems crossing the midline were found in 14 patients (26%). Our findings support the high degree of anatomic variation in the superficial inferior epigastric system, including a significant number of patients lacking superficial-to-deep connections and bilaterally communicating systems. These variations may be identified on preoperative MRA.
authors.affiliation: Department of Plastic Surgery, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Kurlander
authors.affiliation: Department of Plastic Surgery, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Brown
authors.affiliation: Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Iglesias
authors.affiliation: Department of Radiology, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA; Department of Biomedical Engineering, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA; Department of Urology, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gulani
authors.affiliation: Department of Plastic Surgery, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, USA. Electronic address: Hooman.Soltanian@uhhospitals.org.
authors.forename: Hooman T
authors.initials: HT
authors.lastname: Soltanian
mesh_terms: D000009:Abdominal Muscles / Q000098:blood supply / Q000637:transplantation*; D019074:Epigastric Arteries / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D016462:Mammaplasty / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Abdominal wall anatomy; Breast reconstruction; DIEP flap; MR angiography