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Interindividual Variability of the SIEA Angiosome: Effects on Operative Strategies in Breast Reconstruction

Holm, Charlotte M.D., Ph.D.; Mayr, Martina M.D.; Höfter, Eugen M.D.; Raab, Nikolaus M.D.; Ninkovic, Milomir M.D., Ph.D.

Plastic and Reconstructive Surgery: December 2008 - Volume 122 - Issue 6 - p 1612-1620
doi: 10.1097/PRS.0b013e31818a9a3f
Breast: Original Articles

Background: The vascular territory of the superficial inferior epigastric artery (SIEA) remains to be clarified. The SIEA flap has traditionally been classified as a hemiabdominal flap, but recent evidence points to the fact that a sizable superficial artery is capable of supplying the entire abdominal ellipse.

Methods: Twenty-five patients who met the anatomical criteria for undergoing SIEA flap surgery were studied. The abdominal flap was raised on a superficial inferior epigastric pedicle; the dominant musculocutaneous perforators were preserved and clamped above the abdominal fascia on either side. The vascular territory of the superficial epigastric artery and the contribution of the deep epigastric system were visualized using laser-induced fluorescence of indocyanine green. The surgical technique was modified (SIEA, deep inferior epigastric perforator, or bipedicle) based on perfusion measurements and the indication for surgery.

Results: The SIEA vascular territory did not cross the midline in 16 patients (64 percent), and ranged from 0 percent (two patients) to the entire abdominal ellipse (five cases). Fourteen patients (56 percent) were operated on with a unipedicle SIEA flap, five patients (20 percent) were operated on with a bipedicle flap, and in six (24 percent), a conventional deep inferior epigastric perforator flap was used. As a SIEA flap was originally intended in all patients, intraoperative perfusion measurements changed the surgical plan in 11 patients (44 percent).

Conclusions: The SIEA angiosome is variable and ranges from 0 to 100 percent of the lower abdominal flap. Intraoperative perfusion measurements are indispensable for evaluating the sufficiency of this pedicle for tissue transfer, especially if the contralateral flap zones are needed for reconstruction.

Munich, Germany

From the Department of Plastic, Reconstructive, Hand, and Burn Surgery, Bogenhausen Hospital, Technical University Munich.

Received for publication March 25, 2008; accepted May 14, 2008.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Charlotte Holm, M.D., Ph.D. Department of Plastic, Reconstructive, and Hand Surgery; Burn Centre; Klinikum Bogenhausen; Technical University Munich; Englschalkingerstrasse 77; Munich 81925, Germany;

©2008American Society of Plastic Surgeons