title: Computed Tomographic Angiography-Based Planning of Bipedicled DIEP Flaps with Intraflap Crossover Anastomosis: An Anatomical and Clinical Study.
abstract: BACKGROUND
  When using deep inferior epigastric artery perforator (DIEP) flaps in breast reconstruction, harvesting bipedicled flaps can be a valuable option in cases requiring the transfer of a large portion of harvested flaps. Connecting the bilateral deep inferior epigastric arteries (DIEAs) by intraflap crossover anastomosis is one of the most popular methods of constructing bipedicled DIEP flaps. Planning the primary and secondary pedicle configurations for reliable intraflap crossover anastomosis is crucial. To achieve this, detailed anatomical DIEA information might be helpful. However, meticulous planning of bipedicled DIEP flaps based on computed tomographic angiography has not been reported.
  
  
  METHODS
  Detailed anatomical investigation of DIEA branches was conducted using computed tomographic angiographs of 100 hemiabdomens. Thirty-eight prospectively collected patients who underwent breast reconstruction using bipedicled DIEP flaps with intraflap crossover under computed tomographic angiography-based planning were reviewed.
  
  
  RESULTS
  Three intramuscular DIEA branching patterns with distinct branch point topography, branch diameters, and superior continuations cranial to sizable perforators were observed. In the prospective clinical study, a primary pedicle with a recipient branch for intraflap crossover anastomosis could be specified preoperatively using computed tomographic angiography-based anatomical data of the pedicles, including size of DIEA branches or their superior continuation and size of perforators. In all cases, the bipedicle configuration was easily achieved as planned on computed tomographic angiography, and secure perfusion of the entire flap was achieved.
  
  
  CONCLUSIONS
  The authors' results suggest that computed tomographic angiography provides detailed anatomical DIEA information, and comprehensive analysis of these data allows precise planning of bipedicle configurations with intraflap crossover anastomosis in DIEP flaps.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Kyeong-Tae
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010934:Planning Techniques; D013524:Surgical Flaps / Q000098:blood supply* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods