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Computed Tomographic Angiography–Based Planning of Bipedicled DIEP Flaps with Intraflap Crossover Anastomosis: An Anatomical and Clinical Study

Kim, So Young M.D.; Lee, Kyeong-Tae M.D.; Mun, Goo-Hyun M.D., Ph.D.

Plastic and Reconstructive Surgery: September 2016 - Volume 138 - Issue 3 - p 409e-418e
doi: 10.1097/PRS.0000000000002432
Breast: Original Articles

Background: When using deep inferior epigastric artery perforator (DIEP) flaps in breast reconstruction, harvesting bipedicled flaps can be a valuable option in cases requiring the transfer of a large portion of harvested flaps. Connecting the bilateral deep inferior epigastric arteries (DIEAs) by intraflap crossover anastomosis is one of the most popular methods of constructing bipedicled DIEP flaps. Planning the primary and secondary pedicle configurations for reliable intraflap crossover anastomosis is crucial. To achieve this, detailed anatomical DIEA information might be helpful. However, meticulous planning of bipedicled DIEP flaps based on computed tomographic angiography has not been reported.

Methods: Detailed anatomical investigation of DIEA branches was conducted using computed tomographic angiographs of 100 hemiabdomens. Thirty-eight prospectively collected patients who underwent breast reconstruction using bipedicled DIEP flaps with intraflap crossover under computed tomographic angiography–based planning were reviewed.

Results: Three intramuscular DIEA branching patterns with distinct branch point topography, branch diameters, and superior continuations cranial to sizable perforators were observed. In the prospective clinical study, a primary pedicle with a recipient branch for intraflap crossover anastomosis could be specified preoperatively using computed tomographic angiography–based anatomical data of the pedicles, including size of DIEA branches or their superior continuation and size of perforators. In all cases, the bipedicle configuration was easily achieved as planned on computed tomographic angiography, and secure perfusion of the entire flap was achieved.

Conclusions: The authors’ results suggest that computed tomographic angiography provides detailed anatomical DIEA information, and comprehensive analysis of these data allows precise planning of bipedicle configurations with intraflap crossover anastomosis in DIEP flaps.


Seoul, Republic of Korea

From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Received for publication December 23, 2015; accepted April 11, 2016.

The first two authors contributed equally to this work and are co–first authors.

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

Goo-Hyun Mun, M.D., Ph.D., Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 50, Gangnam-gu, Seoul 135-710, Republic of Korea,

Copyright © 2016 by the American Society of Plastic Surgeons