Design Modification And Applications Of The Deep Inferior Epigastric Artery Perforator Propeller Flap

Objective:The deep inferior epigastric artery perforator (DIEAP) flap is commonly used as a free flap for autologous breast reconstruction. As a pedicle flap, it is conventionally based on the main trunk of the deep inferior epigastric artery (DIEA). Extensive rectus abdominis muscle dissection will lead to severe donor site morbidities. Our aim is to use an abdominal propeller flap solely based on perforator of DIEA for various defect reconstruction.Methods:Between 2010 and 2014,10 patients underwent defect reconstruction using the DIEAP propeller flap. There were 5 male and 5 female. The Patients’age ranged from 5 to 67 years (mean,22.8 years). The etiologies included malignant tumor in 5 cases and burn scar contracture in the rest. The defect location comprised abdomen (n=6), lumboabdomen (n=3), and thoracoabdomen (n=1). The perforating vessels were placed in an eccentric position in all of the flaps which were rotated in specific degrees. The flap was then divided into two parts in which the larger part of the flap can be used for defect reconstruction, while the minor part aiding the donor site closure.Results:The defect size ranged from 8 x 5cm to 30 x 9cm (mean:20.41 x 9.53cm). The flap size ranged from 13 x 5cm to 30 x 10cm (mean:22 x 8.47cm) with pedicle length ranging from 2.5-5.5cm (mean:4.15cm). The flap was rotated 180 degrees in six patients,120 degrees in four. The flap was oriented horizontally in six patients, obliquely in three, and vertically in one. Eight flaps survived completely after the surgery. Distal partial necrosis occurred in two flaps which was rotated 180 degrees. Primary donor site closure was achieved in all cases. No functional loss of the rectus muscle and abdominal weakness related to flap harvesting was recognized.Conclusion:Compared to free or pedicle transfer of the conventional DIEAP flap, the abodominal propeller flap based solely on the perforator of the DIEA decreases donor site morbidities owing to preservation of the integrity of the main trunk of the DIEA and minimal muscle dissection. The DIEAP propeller flap might be an alternative option for defect reconstruction of the abdominal and lumbar regions. However, the minimal ideal pedicle length and maximal vascular territory that a single perforator can support need further investigation.