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J Reconstr Microsurg 2024; 40(06): 435-442
DOI: 10.1055/a-2199-3960
Original Article

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Suphalerk Lohasammakul
1   Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Ulsan, Republic of Korea
,
Warangkana Tonaree
3   Division of Plastic and Reconstructive Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Chaiyawat Suppasilp
4   Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Terasut Numwong
1   Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Rosarin Ratanalekha
1   Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
,
Hyun Ho Han 
3   Division of Plastic and Reconstructive Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
› Author Affiliations Funding None.
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Abstract

Background Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline.

Methods Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory.

Results Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA (type 1a) with a diameter of ≥1.4 mm on either side supplied at least half the distance, whereas SIEA with a diameter of <1 mm was limited to the suprapubic area.

Conclusion Designing a SIEA flap island across the midline is feasible when contralateral SIEA is present to augment the contralateral territory (e.g., type 1a SIEA) or in SIEA with a common/superficial external pudendal artery origin. Preoperative imaging studies are important for confirming the SIEA system. When the diameter at the origin of the SIEA flap is larger than 1.4 mm, the blood supply to the ipsilateral and contralateral sides is sufficient to enable safe flap elevation.

Keywords

breast reconstruction - autologous - free flap - SIEA flap - across midline

Note

This study was presented at PRS Korea 2022, Seoul, Korea.


Supplementary Material



Publication History

Received: 27 June 2023

Accepted: 21 October 2023

Accepted Manuscript online:
26 October 2023

Article published online:
18 December 2023

© 2023. Thieme. All rights reserved.

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