Lohasammakul Suphalerk, Flor Mandy, Chaiyasate Kongkrit, Selber Jesse C
From the Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, MI.
Plast Reconstr Surg Glob Open. 2025 Aug 4;13(8):e6993. doi: 10.1097/GOX.0000000000006993. eCollection 2025 Aug.
Robotic-assisted deep inferior epigastric artery perforator (DIEP) flap surgery requires specific vascular anatomy for optimal flap harvest. Deep inferior epigastric artery (DIEA) branching patterns were described as follows: single trunk (type 1), bifurcation (type 2), trifurcation (type 3), and 4-branch (type 4) above the arcuate line. This study demonstrated an additional type 5 anatomy-double trunk at the takeoff from the external iliac artery-as well as an updated classification of DIEA dominant perforator patterns. The significance is described.
A retrospective review of preoperative computed tomographic angiography and intraoperative anatomy of 50 patients who underwent DIEP flap breast reconstruction was performed. A total of 100 DIEAs and their branching and perforator patterns were analyzed.
Out of 100 DIEAs reviewed, there were 59, 34, 4, 1, and 2 classified as types 1, 2, 3, 4, and 5, respectively. Only 1 case with such anatomy contained a dominant perforator that would supply perfusion to the DIEP flap, meaning that in the other case, both arterial trunks were required. The perforator pattern was also described.
DIEA branching and perforator patterns were introduced, including a rare variation in the DIEA's branching pattern: a double trunk. Importantly, one of these trunks might lack a dominant perforator. To minimize donor site complications and ensure adequate blood flow to the flap, it is crucial to identify this variation and the perforator anatomy using preoperative computed tomographic angiography. Ultimately, whether it involves both trunks or just 1, the correct perforator selection is key.
机器人辅助下的腹壁下动脉穿支（DIEP）皮瓣手术需要特定的血管解剖结构以实现最佳的皮瓣切取。腹壁下动脉（DIEA）的分支模式如下：在弓状线以上为单干型（1型）、分叉型（2型）、三叉型（3型）和四分支型（4型）。本研究展示了一种额外的5型解剖结构——在髂外动脉起始处为双干型——以及对DIEA主要穿支模式的更新分类。并描述了其意义。
对50例行DIEP皮瓣乳房重建患者的术前计算机断层血管造影和术中解剖进行回顾性研究。共分析了100条DIEA及其分支和穿支模式。
在100条被评估的DIEA中，分别有59条、34条、4条、1条和2条被分类为1型、2型、3型、4型和5型。只有1例具有这种解剖结构的病例包含一个可为主的穿支，能为DIEP皮瓣提供灌注，这意味着在另一例中，两条动脉干均需保留。还描述了穿支模式。
介绍了DIEA的分支和穿支模式，包括DIEA分支模式中一种罕见的变异：双干型。重要的是，这些主干之一可能缺乏主要穿支。为尽量减少供区并发症并确保皮瓣有足够的血流，利用术前计算机断层血管造影识别这种变异和穿支解剖结构至关重要。最终，无论涉及两条主干还是仅一条，正确选择穿支是关键。
