Peritoneo-cutaneous perforators in deep inferior epigastric perforator flaps (DIEP) : A cadaveric dissection and Computed Tomographic Angiography study
Iain S. Whitaker, BA(Hons) MA Cantab MBBChir MRCS1, Warren M. Rozen, MBBS BMedSc PGDipSurgAnat2, Jeroen M. Smit, MD3, Angeliki Dimopoulou, MD4, Mark W. Ashton, MBBS MD FRACS2, Rafael Acosta, MD EBOPRAS4.
1Welsh Centre for Burns and Plastic Surgery, Swansea, United Kingdom, 2Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Melbourne, Australia, 3Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, Netherlands, 4Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden.
PURPOSE:
Cutaneous perforators that do not originate from the deep inferior epigastric artery (DIEA) are rare, but may significantly affect operative outcome. Peritoneal-cutaneous perforators have been described as a source for augmenting the blood flow to a DIEP flap, however if unrecognized, may compromise flap survival.
METHODS:
We reviewed 375 DIEA perforator (DIEP) flaps (325 with preoperative CTA and 50 cadaveric dissections) to investigate the incidence of this anomaly.
RESULTS:
We detected this variation in 3/325 (1%) of DIEP flaps following preoperative computed tomography. In 1/50 (2%) of the cadaveric specimens, a peritoneal-cutaneous perforator was found and injected with lead oxide contrast. It was shown to fill the cutaneous veins of the majority of the lower abdominal integument.
CONCLUSION:
Peritoneal-cutaneous perforators are rare anatomical variations (4/375: 1.1%) that may have significant ramifications for surgery utilizing the vasculature of the abdominal wall. CTA was significantly able to detect this anomaly and aid operative planning. Preoperative CTA helps to safely identify individual vascular anatomy including rare variations. 
