Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(04): 354-360
DOI: 10.1055/a-2093-8323
Breast/Trunk
Original Article

Deep Inferior Epigastric Perforators Topography for “Island Transverse Rectus Abdominis Musculocutaneous Flap” in Breast Reconstruction

Tae Hyun Kim 
1   Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University Graduate School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
,
Seong Heum Jeong 
1   Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University Graduate School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
,
Hee Chang Ahn 
1   Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University Graduate School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Abstract

Background The Island transverse rectus abdominis musculocutaneous (TRAM) flap is well vascularized with very reliable blood flow, because all perforators of the zone I are included when it is harvested. The number of perforators, topographic mapping, and their relationship with reconstructed outcomes were investigated.

Methods Fifty patients with Island TRAM breast reconstruction from September 2021 to August 2022 were investigated. The zone I was divided into a total of eight sections. Under the loupe magnification, all perforators larger than 0.5 mm in zone I were counted with fine dissection, and photographs were taken in background of vessel loops. Complications like flap necrosis, seroma, and hematoma were also investigated.

Result There are 12 ideal perforators on average in zone I such as one perforator in section I, II, IV, V, VI, VIII, and three perforators in section III and VII. However, two perforators (M6 and L6) below arcuate line were sacrificed in the time of flap harvest to prevent hernia. Island TRAM included 10 perforators on average (5 perforators in each side) above arcuate line to be transferred to the recipient site. Only minor complications were identified.

Conclusion The Island TRAM flap includes 10 perforators to get the vigorous blood flow. The periumbilical to upper medial perforators become more dominant in the perfusion of the flap after deep inferior epigastric artery division. Well preserved perforators will guarantee the satisfactory breast reconstruction with the least complication.

Keywords

perforators - Island TRAM flap - breast reconstruction - topographic mapping

Authors' Contributions

Conceptulization: T.H.K., S.H.J., and H.C.A.

Data curation: T.H.K., S.H.J., and H.C.A. Formal analysis: T.H.K.

Investigation: T.H.K. and H.C.A.

Methodology: T.H.K., S.H.J., and H.C.A.

Project administration: T.H.K. S.H.J., and H.C.A.

Writing original draft: T.H.K.

Writing – review and editing: T.H.K. and H.C.A.


Ethical Approval

This study was conducted following the approval of Our Institutional Review Board (IRB No. 2022–09–046–002) and performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained.


Patient Consent

The patient provided written informed consent for the publication and the use of her clinical images.




Publication History

Received: 14 February 2023

Accepted: 10 May 2023

Accepted Manuscript online:
15 May 2023

Article published online:
02 August 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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