Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(02): 153-155
DOI: 10.1055/a-2006-0747
Breast/Trunk
Idea and Innovation

Encountering Peritoneo-Cutaneous Perforators in Microsurgical DIEP Flap Breast Reconstruction

Duncan Loi 
1   Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia
2   Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
,
Justin L. Easton 
1   Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia
2   Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
,
Warren M. Rozen 
1   Department Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, Australia
2   Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria, Australia
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Abstract

The vascular anatomy of the deep inferior epigastric artery perforator (DIEP) flap has been well studied in the planning for autologous breast reconstruction. Preoperative imaging with computed tomography angiography (CTA) provides accurate assessment of this vascular anatomy, which varies widely across patients. Several papers to date have described their encounter with an anomalous “epiperitoneal” or “peritoneo-cutaneous” perforator during flap harvest, a perforator that pierces the posterior rectus sheath from a peritoneal origin, to traverse rectus abdominis and supply the DIEP flap integument. In the course of over 3,000 CTA assessments of the vascular anatomy of the abdominal wall, we have encountered dominant peritoneo-cutaneous perforators in 1% of cases, and smaller perforators seen in many more cases, approaching 5% of cases. With increasing sensitivity of imaging, we also describe a unique case of multiple large bilateral peritoneo-cutaneous perforators, and present these findings in the context of DIEP flap harvest. It is critical to recognize these peritoneo-cutaneous perforators preoperatively to avoid mistaking them for a DIEP during the raising of a DIEP flap. The routine use of preoperative CTA enables the safe identification of individual vascular anatomy, including significant peritoneo-cutaneous perforators.

Keywords

microsurgery - breast reconstruction - anatomy

Author Contributions

D.L.: Writing–original draft, writing–review & editing; J.L.E.: Data curation, formal analysis, methodology, project administration; W.M.R.: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing–original draft, writing–review & editing.


Patient Consent

Written consent was obtained from the patient for the publication of images or data related to the patient.


Ethical Approval

Approval numbers 2006.038; 2006.231 and HREC86700PH-2022.




Publication History

Received: 02 July 2022

Accepted: 28 December 2022

Accepted Manuscript online:
03 January 2023

Article published online:
28 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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