title: Determining the best recipient vessel site for autologous microsurgical breast reconstruction with DIEP flaps: An anatomical study.
abstract: BACKGROUND
  The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites.
  
  
  METHODS
  Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations.
  
  
  RESULTS
  The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009).
  
  
  CONCLUSIONS
  This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France; Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France; Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France. Electronic address: martin.lhuaire@etudiant.univ-reims.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Lhuaire
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France.
authors.forename: Mikael
authors.initials: M
authors.lastname: Hivelin
authors.affiliation: Department of Research, Innovation and Biostatistics, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.affiliation: Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Abrahams
authors.affiliation: Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Fontaine
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D019074:Epigastric Arteries / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D013895:Thoracic Arteries / Q000033:anatomy & histology*; D013909:Thorax / Q000098:blood supply*; D014680:Veins / Q000033:anatomy & histology*
keywords: Anatomical study; Autologous breast reconstruction; DIEP flap; Microsurgery; Vessel diameter