The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women

Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery.

Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level.

Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (±12.87) mm, and -8.14 (±15.24) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (±0.39) mm and 1.37 (±0.33) mm, and they were found at a mean depth of 9.75 (±2.67) mm and 8.33 (±2.65) mm, respectively.

Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

Keywords

Epigastric arteries - Regional anatomy - Koreans - Breast reconstruction

This article was presented at the Korean Society of Plastic and Reconstructive Surgeons on November 1-3, 2013 in Seoul, Korea.

Publication History

Received: 13 June 2014

Accepted: 18 August 2014

Article published online:
05 May 2022

• References

• 1 Spiegel AJ, Khan FN. An Intraoperative algorithm for use of the SIEA flap for breast reconstruction. Plast Reconstr Surg 2007; 120: 1450-1459
• 2 Reardon CM, O'Ceallaigh S, O'Sullivan ST. An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 2004; 57: 515-519
• 3 Selber JC, Samra F, Bristol M. et al. A head-to-head comparison between the muscle-sparing free TRAM and the SIEA flaps: is the rate of flap loss worth the gain in abdominal wall function?. Plast Reconstr Surg 2008; 122: 348-355
• 4 Zenn MR. Insetting of the superficial inferior epigastric artery flap in breast reconstruction. Plast Reconstr Surg 2006; 117: 1407-1411
• 5 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56: 243-253
• 6 Dorafshar AH, Januszyk M, Song DH. Anatomical and technical tips for use of the superficial inferior epigastric artery (SIEA) flap in breast reconstructive surgery. J Reconstr Microsurg 2010; 26: 381-389
• 7 Hsieh F, Kumiponjera D, Malata CM. An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars--results from a single surgeon's experience. J Plast Reconstr Aesthet Surg 2009; 62: 1650-1660
• 8 Ulusal BG, Cheng MH, Wei FC. et al. Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels. Plast Reconstr Surg 2006; 117: 1395-1403
• 9 Imanishi N, Nakajima H, Minabe T. et al. Anatomical relationship between arteries and veins in the paraumbilical region. Br J Plast Surg 2003; 56: 552-556
• 10 World Health Organization Western Pacific Region, International Association for the Study of Obesity, International Obesity Task Force. Redefining obesity and its treatment [Internet]. Geneva: World Health Organization; 2000. [cited 2014 Aug 22] Available from: http://www.who.int/nutrition/publications/obesity/09577082_1_1/en/
• 11 Hester Jr TR, Nahai F, Beegle PE. et al. Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery. Plast Reconstr Surg 1984; 74: 657-670
• 12 Granzow JW, Levine JL, Chiu ES. et al. Breast reconstruction using perforator flaps. J Surg Oncol 2006; 94: 441-454
• 13 Grotting JC. The free abdominoplasty flap for immediate breast reconstruction. Ann Plast Surg 1991; 27: 351-354
• 14 Chevray PM. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Plast Reconstr Surg 2004; 114: 1077-1083
• 15 Arnez ZM, Khan U, Pogorelec D. et al. Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap. Br J Plast Surg 1999; 52: 276-279
• 16 Stern HS, Nahai F. The versatile superficial inferior epigastric artery free flap. Br J Plast Surg 1992; 45: 270-274
• 17 Holm C, Mayr M, Hofter E. et al. Interindividual variability of the SIEA Angiosome: effects on operative strategies in breast reconstruction. Plast Reconstr Surg 2008; 122: 1612-1620
• 18 Woodworth BA, Gillespie MB, Day T. et al. Muscle-sparing abdominal free flaps in head and neck reconstruction. Head Neck 2006; 28: 802-807
• 19 Rizzuto RP, Allen RJ. Reconstruction of a partial mastectomy defect with the superficial inferior epigastric artery (SIEA) flap. J Reconstr Microsurg 2004; 20: 441-445
• 20 Rozen WM, Chubb D, Grinsell D. et al. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: a clinical anatomical study. Microsurgery 2010; 30: 386-391
• 21 Gusenoff JA, Coon D, De La Cruz C. et al. Superficial inferior epigastric vessels in the massive weight loss population: implications for breast reconstruction. Plast Reconstr Surg 2008; 122: 1621-1626
• 22 Fathi M, Hatamipour E, Fathi HR. et al. The anatomy of superficial inferior epigastric artery flap. Acta Cir Bras 2008; 23: 429-434
• 23 Schaverien M, Saint-Cyr M, Arbique G. et al. Arterial and venous anatomies of the deep inferior epigastric perforator and superficial inferior epigastric artery flaps. Plast Reconstr Surg 2008; 121: 1909-1919
• 24 Vega SJ, Bossert RP, Serletti JM. Improving outcomes in bilateral breast reconstruction using autogenous tissue. Ann Plast Surg 2006; 56: 487-490
• 25 Holm C, Mayr M, Hofter E. et al. The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery. J Plast Reconstr Aesthet Surg 2007; 60: 946-951