Dallas, Texas; Washington, D.C.; and Rochester, Minn. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Department of Plastic Surgery, Georgetown University Medical Center; and the Division of Plastic and Reconstructive Surgery, Mayo Clinic.
Plast Reconstr Surg. 2014 Nov;134(5):810e-821e. doi: 10.1097/PRS.0000000000000625.
The deep inferior epigastric artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap.
The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy.
The perforators originating from the deep inferior epigastric artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course (<4 cm) is most common (61 to 80 percent), followed by a long intramuscular course (>4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection.
The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.
深下腹直肌穿支皮瓣（DIEP）是最常用的皮瓣之一，用于重建。皮瓣的解剖结构在患者之间甚至在同一患者中差异很大。作者进行了全面的综述，以充分描述 DIEP 皮瓣的血管解剖结构。
作者对 1993 年至 2012 年间发表的关于 DIEP 皮瓣血管解剖结构的 MEDLINE、Ovid 和 PubMed 文章进行了检索。首先筛选摘要，然后是全文，最后是手动参考检查。共确定并完整回顾了 60 篇相关文章。作者综合了所有关于 DIEP 皮瓣血管解剖结构的描述。
发自深下腹直肌动脉的穿支可分为肌皮穿支或非肌皮穿支。肌皮穿支最常见（33%至 100%），其次是非肌皮穿支（0%至 67.6%）。肌皮穿支中，短肌内走行（<4cm）最常见（61%至 80%），其次是长肌内走行（>4cm；9%至 26%）和垂直走行（3%至 26%）。已经描述了两种筋膜下模式，直接筋膜穿透比筋膜下走行更常见。两种非肌皮穿支类型，正中旁型（<46.4%）和腱旁型（<67.6%），最适合解剖。
DIEP 皮瓣的血管解剖结构存在显著的变异性。尽管如此，还是发现了几种肌皮和非肌皮穿支类型的模式。对这些模式的进一步了解将提高对解剖变异的认识，并增强基于证据的穿支选择的使用。
