Classification and applications of the pedicled deep inferior epigastric artery perforator flap

Abstract

Objective To propose a classification method and explore the indications and technical tips of the pedicled deep inferior epigastric artery perforator (DIEAP) flap. Methods From July 2005 to December 2017, 18 patients underwent soft-tissue defect repairment using the pedicled DIEAP flap. The defect locations included abdomen (n=6), iliolumbar region (n=2), perineum (n=4), and proximal thigh (n=6). The flaps were divided into two types. The type Ⅰ were further subdivided into two subtypes. The type Ⅰa was solely based on the DIEAP. The type Ⅰb was also based on the DIEAP, however, the main trunk of the deep inferior epigastric vessels needs to be divided to further improve the pedicle length. The type Ⅱ was the traditional pedicled DIEAP flap. Results Twenty flaps were included in this series. The mean size and pedicle length of the 4 flaps in type Ⅰa were 19.0 cm× 6.5 cm and 2.88 cm respectively. The rotation angles were 60 degrees (n=1), 120 degrees (n=1), and 180 degrees (n=2). The 3 flaps of type Ⅰb was 26 cm × 6 cm, 20 cm × 5 cm and 24 cm × 7 cm in size, and the pedicle lengths of them were 6 cm, 7 cm and 7 cm, respectively. All flaps in this subtype were rotated by 180 degrees. The mean size and pedicle length of the 13 type Ⅱ flaps were 21.46 cm × 9.38 cm and 11.08 cm. 17 flaps completely survived postoperatively. Small-sized necrosis of the distal portion of the occurred in 3 flaps. All patients were followed up for 6 months to 5 years, with the averaged 11 months follow-up time. All patients were satisfied with the final outcomes. Tumor recurrence was not noticed for the oncological patients. Conclusions The pedicled DIEAP has remarkable versatility in the defect repairment for the regions including abdomen, iliolumbar region, proximal thigh, and perineal region. Combining with the propeller flap concept, the clinical application of pedicled DIEAP could be further expanded. The pedicled DIEAP is a reliable reconstructive method for defect repairment in abdominal and iliolumbar regions. Key words: Deep inferior epigastric artery perforator flap; Pedicled flap; Reconstruction