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. 2023 Aug 2;50(4):354-360.
doi: 10.1055/a-2093-8323. eCollection 2023 Jul.

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

Tae Hyun Kim  1 , Seong Heum Jeong  1 , Hee Chang Ahn  1
Affiliations

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

Tae Hyun Kim et al. Arch Plast Surg. .

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: Island TRAM flap; breast reconstruction; perforators; topographic mapping.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
The zone I of the Island transverse rectus abdominis musculocutaneous flap was sectioned into eight sections. (4 areas such as upper, lateral, lower umbilical areas, and lower arcuate line were sectioned. Then these four areas were divided vertically in the center.)
Fig. 2
Fig. 2
Under the loupe magnification, all perforators larger than 0.5 mm were finely dissected in the zone I. Then they were counted and topographically marked.
Fig. 3
Fig. 3
( A) The design before surgery and ( B ) the perforator and marks its location by classifying compartments according to criteria. ( C ) The superior epigastric artery was marked with a vessel loop to narrow the muscle pedicle. ( D )The direct closure of the fascia through Island transverse rectus abdominis musculocutaneous.
Fig. 4
Fig. 4
Topographic mapping for the distribution of perforator's location. Medial perforators (M1–6) and lateral perforators (L1–6).
Fig. 5
Fig. 5
Distribution and number according to section of perforator on medial side and lateral side.
See this image and copyright information in PMC

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