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. 2023 Mar 28;50(2):153-155.
doi: 10.1055/a-2006-0747. eCollection 2023 Mar.

Encountering Peritoneo-Cutaneous Perforators in Microsurgical DIEP Flap Breast Reconstruction

Duncan Loi  1   2 , Justin L Easton  1   2 , Warren M Rozen  1   2
Affiliations

Encountering Peritoneo-Cutaneous Perforators in Microsurgical DIEP Flap Breast Reconstruction

Duncan Loi et al. Arch Plast Surg. .

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: anatomy; breast reconstruction; microsurgery.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Computed tomographic angiogram (CTA) axial slices demonstrating a peritoneo-cutaneous perforator (blue arrows).
Fig. 2
Fig. 2
Intraoperative photograph demonstrating three large peritoneo-cutaneous perforators, all over 1 mm in diameter.
See this image and copyright information in PMC

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