Encountering Peritoneo-Cutaneous Perforators In Microsurgical DIEP Flap Breast Reconstruction

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 3000 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 recognise these peritoneo-cutaneous perforators preoperatively to avoid mistaking them for a deep inferior epigastric artery perforator 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.

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch

References and Relationships

• Bibliographic citation: Encountering Peritoneo-Cutaneous Perforators In Microsurgical DIEP Flap Breast Reconstruction ; day:03 ; month:01 ; year:2023 ; Archives of Plastic Surgery ; (03.01.2023)

Contributors, Places and Time

• Contributor: Loi, Duncan ; Easton, Justin L. ; Rozen, Warren Matthew

Further information

• DOI: 10.1055/a-2006-0747
• URN: urn:nbn:de:101:1-2023021612322487294126
• Rights: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 14.08.2025, 10:58 AM CEST