Intersection-splitting Deep Inferior Epigastric Perforator Flap

• Published in: Plastic and reconstructive surgery. Global open Vol. 7; no. 10; p. e2490
• Main Authors: Andejani, Doaa F, AlThubaiti, Ghazi A
• Format: Journal Article
• Language: English
• Published: Copyright The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved 01.10.2019; Wolters Kluwer Health; Wolters Kluwer
• Subjects: Ideas and Innovations
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000002490

Preserving a dynamic abdominal wall is the premise behind the evolution of TRAM flaps into deep inferior epigastric perforators (DIEPs). Performing a true DIEP flap requires a highly refined surgical technique and often times involves a tedious intramuscular dissection which may account for the slow, albeit steady adaptation of DIEPs in breast reconstruction. This article intends to address a scenario in which an additional perforator from a different row is needed. Based on our current knowledge of the abdominal wall and its embryology, we propose splitting the rectus abdominis muscle through the intersections while recruiting a second perforator instead of converting the procedure into MS-TRAM or performing a second anastomosis through the perforator exchange technique, APEX. This potentially saves time and simplifies the procedure while maintaining the integrity of the abdominal wall.