A cadaveric study on abdominal wall perforators from the deep inferior epigastric artery: application to flap surgery

The deep inferior epigastric perforator (DIEP) flap is based on the perforator arteries of the deep inferior epigastric artery. The rectus abdominis muscle provides an excellent myocutaneous flap, either pedicled or free, because of the rich vascularity provided by the epigastric vessels and separation of muscle belly from the surrounding tissue within the rectus sheath. The study was conducted on 30 adult cadavers. The length and width of the rectus abdominis muscle and length, direction, muscular branches of the perforator, branching pattern and termination of the inferior epigastric artery were observed. The diameter of inferior epigastric artery at the point of origin was between 2.1 and 3.5 mm. The artery dividing into two major branches was seen in 11 cases, the lateral branch being dominant in 3 cases, the medial branch in 3, both branches having equal caliber in 5 cases and in 19 cases there was one central axis with multiple side branches. The total number of perforators was 243. In 101 cases diameters were between 0.5 mm and 1.0 mm, and 139 cases exceeded 1.0 mm. The average running distance was 7.20 mm. Fifty-one percent perforators were present above the level of the umbilicus and 49% below. On each side 43% ideal perforators were present. A majority of ideal perforators (72%) was concentrated 4 cm superiorly, 7 cm inferiorly and 5 cm laterally to the umbilicus. Our data indicate that 43% of all perforators with diameters over 1 mm are ideal perforators, and most that are located about a 5 cm radius around the umbilicus can easily be dissected.