chapter  23
20 Pages

Surgical Principles of Deep Inferior Epigastric Artery and Deep Superior Epigastric Artery Perforator Flap

References ...................................................................................................................................... 414

The main blood supply of the anterior abdominal wall traditionally has been described as being supplied by a system of deep and supercial named arteries. The deep system is divided into the superior abdomen which has primary supplies by the deep superior epigastric artery (DSEA) and the inferior abdomen supplies by the deep inferior epigastric artery (DIEA). DSEA is a continuation course from the internal thoracic artery or internal mammary artery (IMA) and DIEA from external iliac artery. For the purpose of reducing confusion, the internal thoracic artery as used in the anatomical literature will be referred to as IMA as referred to by many clinicians. These vessels have an intramuscular course within the rectus abdominis (RA) muscle which they supply. They anastomose within the RA muscle midway between the xiphoid and the umbilicus. A ap can be raised as muscle, myocutaneous, or fasciocutaneous ap. Rectus muscle ap (transverse RA myocutaneous [TRAM] or vertical RA muscle [VRAM]) can be raised as superior pedicle based on the DSEA or inferior pedicle based on the DIEA. Better understanding of perforator ap and improvement in microsurgery has allowed plastic and reconstructive surgeons to harvest a ap based entirely on the perforator which allows the muscle to be spared, thus reducing the donor site morbidity. These aps have become a work-horse ap in reconstructive surgery. DIEP ap has become widely accepted by both surgeons and patients in autologous breast reconstruction worldwide. Similarly, TRAM and VRAM aps are commonly used in anterior thorax reconstruction.