Abstract
Background The difficulty of elevating a deep inferior epigastric perforator (DIEP) flap largely
depends on the intramuscular course of the vessel and the perforator. Previous studies,
however, have lacked histologic descriptions of the vessels and surrounding structures.
The present study analyzed the histologic aspects of the deep inferior epigastric
vessels and perforators, focusing on their perivascular relationships with muscle
fibers.
Methods The abdomen of a cadaver was histologically evaluated to identify intramuscular deep
inferior epigastric vessels. Tissue samples were stained with hematoxylin and eosin
and with Masson trichrome stain to visualize fibrous components. Twenty-one DIEPs
from 12 patients were also evaluated to determine the histologic aspects of the perivascular
structure. In the cross-section of each perforator and adjacent tissue, the perforator-to-muscle
distance and trichrome-stained area were measured, and the correlation of the perforator
size with the perforator-to-muscle distance and the percent collagenous portion of
the distance were determined.
Results Histologic analysis showed that the deep inferior epigastric vessels and perforators
were encased by perimysial connective tissue and were not in direct contact with the
muscle fibers. The smaller perimysia branched out from the larger perimysia, forming
an interconnecting network structure. Correlation analysis showed that larger vessels
had more collagenous portions in the perimysial structures (Spearman's ρ = 0.537,
p = 0.012).
Conclusion The deep inferior epigastric vessels and perforators reside in a perimysial fibroadipose
tissue network. This may provide surgeons with a microscopic perspective during DIEP
dissections. Having an idea of the perforator anatomy in microscopic level can help
us to perform safer perforator dissections.
Keywords
perforator flap - deep inferior epigastric perforator flap - histology
