Superior Epigastric Artery Perforator Research Articles

Internal mammary artery perforator (IMAP) flap plus superior epigastric artery perforator (SEAP) flap as salvage breast reconstruction after multiple surgical failures: a case report

Internal mammary artery perforator (IMAP) flap plus superior epigastric artery perforator (SEAP) flap as salvage breast reconstruction after multiple surgical failures: a case report

Ex Vivo Subnormothermic Preservation of Porcine Superior Epigastric Artery Perforator Flaps

Ex Vivo Subnormothermic Preservation of Porcine Superior Epigastric Artery Perforator Flaps

Uvećani perforator režnjevi prednjeg torakalnog i abdomonalnog zida - novi pristup autolognoj rekonstrukciji dojke

Aim. To develop methods for obtaining enlarged perforating flaps on the anterior surfaces of the thoracic and abdominal walls. Material and methods: The study included 16 patients with post-burn breast deformities aged from 5 to 22 years. In the upper part of the anterior surface of the chest, the flaps were formed on the basis of 2, 3 anterior intercostal artery perforator and thoracoacromial artery perforator with the inclusion of the vascular network of the thoracic branch of the supraclavicular artery. In the lower part of the thoracic and upper abdominal wall, there were also enlarged flaps based on the superior epigastric artery perforator with the connection of vascular networks 6, 7 anterior intercostal artery perforator and perforator deep inferior epigastric artery. The obtained flaps were moved by direct advancement, rotation and transposition methods. Results: The largest area of the wound defect was closed with flaps that were moved by rotation and it was 1.8 times larger than the area of wounds closed by direct advancement and 1.3 times larger than if using transposition flaps. The use of stretched perforating flaps from the anterior surface of the thoracic and abdominal walls allowed to obtain a positive result in 90.4% of cases with the short-term treatment, and in all cases with the long-term treatment. Conclusion: A simple technique based on the proposed methods can be widely used for the reconstruction of the upper and lower quadrants of the breast and intermammary and submammary spaces.

Superior epigastric artery perforator flap for reconstruction of deep sternal wound infection.

The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the superior epigastric artery perforator (SEAP) flaps to repair sternal defect. Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14-27 × 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.

Autologous islanded breast enhancement by reversed abdominoplasty (AIBERA) flap

We present a surgical technique of recuperating tissue from the upper abdominal wall, based on the superior epigastric artery perforators, thereby providing tissue for autologous augmentation of the breasts in combination with reversed abdominoplasty in patients after massive weight loss. A 20-year-old woman was seen in the outpatient clinic with a large residual skin laxity of the superior abdomen following circular abdominoplasty after weight loss of 55 kg. She was dissatisfied with the appearance of her breasts and superior abdomen. Bilaterally, pedicled SEAP flaps were harvested from the epigastric region. In addition, a reversed abdominoplasty was performed. The flaps were secured in a retroglandular pocket superiorly to the anterior chest wall in order to augment the breasts. The islanded pedicled SEAP flap in combination with reversed abdominoplasty is a useful and safe technique for autologous breast augmentation following massive weight loss. In addition, the potential risk of implant-related complications is eliminated as implants are replaced by autologous tissue. Level of evidence: Level V, therapeutic study.

Less Invasive Management of Tissue Deficits for Deep Sternal Wound Infections.

Background:The frequency of sternomyelitis after cardiovascular surgery has been reported to be 0.4% -5%.Methods:The treatment method used for 47 patients (29 male and 18 female) who developed sternomyelitis after sternotomy with tissue defects in the chest was examined retrospectively.Results:Of the original conditions, the most frequent was coronary artery disease undergoing bypass grafting (22 cases, 46.8%), followed by acute aortic dissection (10 cases, 21.3%). The number of times debridement was performed was: once, 35 cases; twice, 11 cases; 7 times, 1 case; and unknown, 2 cases. The most frequent time of occurrence of sternomyelitis was within 2 weeks after surgery (12 patients, 25.5%). A residual internal thoracic artery remained on both sides in 28 cases (59.6%), and only on the right side in 17 cases (36.2%); there was no remaining one in 2 cases (4.2%). The reconstruction method was a pectoralis major musculocutaneous flap in 31 cases (66.0%), internal mammary artery perforator flap in 7 cases (14.9%), rectus abdominis musculocutaneous flap in 4 cases (8.5%), omentum transplant in 3 cases (6.4%), superior epigastric artery perforator flap in 2 cases (4.3%), external abdominal oblique muscle flap in 1 case (2.1%), and latissimus dorsi musculocutaneous flap in 1 case (2.1%). The internal mammary artery perforator flap and the superior epigastric artery perforator flap have been effective treatment.Conclusions:In 47 patients, our method of treatment for tissue defects of the chest wall after sternal osteomyelitis was examined, and an algorithm using less invasive management was proposed.

A sequence of flaps and dissection exercises in the living model to improve the learning curve for perforator flap surgery

IntroductionThe training to learn how to perform perforator flaps requires practice on a living model to optimize dissection and to evaluate outcome. The purpose of this study was to describe a training model that optimizes the use of animals in order to perform the maximum number of exercises per animal. Material and methodsThe sequence has been planned and practiced by the first and last author, recorded perfected and implemented in a two-day surgical course. The sequence was then evaluated by the trainers and the trainees by means of a questionnaire. ResultsAll students were able to complete the sequence of exercises before the end of the second day except two (8/10) who could not complete one exercise each. The students considered the Deep Superior Epigastric Artery Perforator flap the most difficult to perform, being the most technically demanding. The sequence of exercises was judged either easily reproducible or reproducible by all the students. Two students suggested to postpone the DSEAP flap to the second day, after some training, to optimize the experience with the most challenging and rewarding flap. ConclusionsThe training sequence proposed offers a wide range of exercises and allows four trainees, divided in two teams, to work and learn on the same animal. They can perform a wide range of flaps and also harvest the internal mammary vessels. The living model allows for evaluation of the quality of the surgical performance, judged by the difficulties and complications encountered during dissection, and finally through the feedback of flap perfusion.

Thoracodorsal Artery Perforator and Superior Epigastric Artery Perforator Flaps for Volume Replacement Oncoplastic Breast Surgery.

Introduction Breast conservation therapy (BCT) and oncoplastic breast surgery (OBS) are now established modalities of treatment for breast cancer, with proven oncological safety. Traditionally, latissimus dorsi (LD) flaps have been the one-stop solution workhorse when volume replacement is needed. We present our experience with thoracodorsal artery perforator (TDAP) and superior epigastric artery perforator (SEAP) flaps. These flaps allow the preservation of muscle structure and function. Material and Methods Data were collected prospectively of patients in whom pedicled perforator flaps after BCT were used. A handheld 8-MHz audio Doppler was used to locate the perforators. TDAP flaps were used in four patients, whereas SEAP flaps were used in two patients. Skin paddle sizes ranged from 10 × 3 cm to 21 × 7 cm. Results TDAP flaps were used in four patients, whereas SEAP flaps were used in two patients All flaps survived. No flap had partial necrosis or fat necrosis. All donor sites were closed primarily and healed uneventfully, and none had a seroma requiring aspiration. Conclusion TDAP flaps can be selectively employed when the LD muscle function needs to be preserved. SEAP flaps can also be employed as a rare option in case of lower inner quadrant defects. Pedicled perforator flaps are a useful and reliable option for volume replacement OBS in select patients for reconstructing partial mastectomy defects.

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes have been available for years in many surgical fields. We used the female (because they are easy to handle for the procedure) Yorkshire pigs for the head and neck reconstruction by harvesting the deep inferior epigastric artery perforator or the superior epigastric artery perforator flap. The anastomosis site (neck skin defect or tracheal wall defect) was prepared via the dissection of the common carotid artery and the internal jugular vein, in which 3.5× loupe magnification was used for anastomosis as we use on human cases in real life. This procedure demonstrates a new training method using a reliable learning model and provides a detailed anatomy in a live scenario. We focused on the ischemia time, harvesting, vessel anastomosis, and designing the flap to fit the defect site. This model improves tissue handling and with the use of proper instruments can be repeated many times so that the surgeon is fully confident before starting the surgery on humans.

Porcine experimental model for perforator flap raising in reconstructive microsurgery

BackgroundPerforator free flap–based reconstruction of the head and neck is a challenging surgical procedure and needs a steep learning curve. A reproducible mammal large animal model with similarities to human anatomy is relevant for perforator flap raising and microanastomosis. The aim of this study was to assess the feasibility of a swine model for perforator-based free flaps in reconstructive microsurgery. MethodsEleven procedures were performed under general anesthesia in a porcine model, elevating a skin flap vascularized by perforating musculocutaneous branches of the superior epigastric artery to evaluate the relevance of this model for head and neck reconstructive microsurgery. ResultsThe anterior abdominal skin perforator–based free flap in a swine model irrigated by the superior epigastric artery was elevated in eleven procedures. In six of these procedures, we could perform an arterial and venous microanastomosis to the great vessels located in the base of the neck. ConclusionsThe porcine experimental model of superior epigastric artery perforator–based free flap reconstruction offers relevant similarities to the human deep inferior epigastric artery perforator flap. We could demonstrate this model as acceptable for perforator free flap training due to the necessity of perforator and pedicle dissection and transfer to a distant area.

Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application

Although there are various methods for tracheal reconstruction, such as a simple approximation with suturing and coverage with adjacent soft tissue or muscle, large defects >50% of the tracheal length still present a clinical challenge. Tissue engineering, a recent promising way to possibly resolve this problem, requires a long preparatory period for stem cell seeding on a scaffold and relatively invasive procedures for stem cell harvesting. As an alternative, we used a vascularized myofascial flap for tracheal reconstruction. In four porcine models, the deep inferior epigastric perforator (DIEP) was used in two and the superior epigastric artery perforator (SEAP) in two. Transformation of the surface of the transplanted myofascial flap was analyzed in the airway environment. The flaps failed in the DIEP group due to venous congestion. At 12 weeks postoperatively, none of SEAP group showed any signs of respiratory distress; the inner surface of the implant exhibited stratified squamous epithelium with sparse cilia. In the clinical setting, a patient who underwent a tracheal reconstruction with a vascularized myofascial flap and 2-year follow-up was in good health with no respiratory distress symptoms.

Abstract: Principles and Algorithm for the Microsurgical Treatment of Unstable Keloids on the Trunk after Burn Injury

INTRODUCTION: Unstable keloids are one of the most frustrating clinical problems in wound healing and the pathogeneses remains largely unknown.1 To date, little is known in the literature about the microsurgical management of unstable and middle-sized keloids on the trunk, and a clear consensus is lacking.2 Perforator flaps are thin and pliable, have a robust blood supply, potentially release the scar-site tension effectively and may provide an outcome with well-matched color, thickness, and texture.3,4 In this study, we provide a versatile algorithm by using various pedicled and free perforator flaps for the treatment of keloids on the trunk. MATERIALS AND METHODS: Patients with a history of multiple treatments of middle-sized keloids on various regions of the trunk were included. Color Doppler ultrasound (CDU) and multidetector-row computed tomographic angiography (MDCTA) were performed preoperatively. Depending on the location of the keloid, the following flaps were used: superficial circumflex iliac artery perforator (SCIP) flap, internal mammary artery perforator (IMAP) flap, superior epigastric artery perforator (SEAP) flap, anterior intercostal artery perforator (AICAP) flap, deep inferior epigastric artery perforator (DIEP) flap and anterolateral thigh (ALT) flap. RESULTS: Between June 2013 to June 2015, 29 patients (15 male and 14 females) with a mean age of 41 ± 15years were treated. Totally, we performed 5 free SCIP flaps, 2 pedicled SCIP flaps, 8 IMAP flaps, 6 SEAP flaps, 3 AICAP flaps, 4 DIEP flaps and 1 ALT flap. The mean flap size was 83 ± 36cm2 and the mean flap thickness was 14.8 ± 5mm. One partial distal necrosis occurred after a pedicled AICAP reconstruction, which healed conservatively. After a mean follow-up of 5 ± 3months, all surviving flaps showed excellent thickness, texture and color match. Importantly, there was no need for secondary debulking surgery. The donor site healed well after primary closure in all patients. CONCLUSION: We successfully applied various free and pedicled perforator flaps for the treatment of unstable keloids on the trunk. Based on our experience, we provide a useful and reliable algorithm in order to achieve the best possible outcome. No disclosures REFERENCES: 1. Ogawa R, Chin MS. Animal models of keloids and hypertrophic scars. J Burn Care Res 2008;29(6):1016–1017 2. Wang J, Min P, Grassetti L, et al. Preliminary Outcomes of Distal IMAP and SEAP Flaps for the Treatment of Unstable Keloids Subject to Recurrent Inflammation and Infections in the Lower Sternal and Upper Abdominal Areas. J Reconstr Microsurg 2015 3. Hong JP, Choi DH, Suh H, et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014;30(7):491–496 4. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989;42(6):645–648

Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap

The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the superior epigastric artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails.

Preliminary Outcomes of Distal IMAP and SEAP Flaps for the Treatment of Unstable Keloids Subject to Recurrent Inflammation and Infections in the Lower Sternal and Upper Abdominal Areas

We present the clinical application of the sixth internal mammary artery perforator (IMAP) and superior epigastric artery perforator (SEAP) flaps for the treatment of defects resulting from the excision of large lower sternal and upper abdominal keloids. Perforator selection and flap design were based solely on preoperative multidetector-row computed tomographic angiography (MDCTA) of the areas adjacent to the soft tissue defects. Between January 2009 and June 2014, 15 patients with large, unstable keloids subject to recurrent inflammation and infections and with a history of multiple failed treatments underwent surgical excision and early postoperative radiation therapy. The defects were located in the upper abdomen (n = 6) or lower sternum (n = 9). All patients underwent preoperative MDCTA for perforator localization. A total of 15 patients underwent keloid removal followed by IMAP (n = 10) and SEAP (n = 6) flap coverage combined with early postoperative low-dose radiation therapy (350 cGy/5 fractions/5 days or 400 cGy/4 fractions/4 days). Flap sizes ranged from 9 × 5 to 17 × 6 cm. Only one IMAP flap developed a 2 × 2 cm tip necrosis, which was managed with dressing changes. The remaining flaps healed uneventfully with no keloid recurrence at 23.4 months. In all cases, the perforator location determined by preoperative MDCTA was precisely consistent with the intraoperative findings. The sixth IMAP and SEAP flaps combined with early postoperative radiation therapy provided a valid and feasible approach for the surgical treatment of large keloids in the lower sternal and upper abdominal. MDCTA enabled detailed preoperative assessment of the perforators, facilitating both flap design and dissection, and saving operating time. Although longer follow-up is required, these preliminary results are encouraging.

Porcine model for free-flap breast reconstruction training

Free-flap breast reconstruction is a challenging surgical procedure with a steep learning curve. A reproducible large animal model could be relevant for free-flap harvesting and microsurgical anastomosis training. The aim of this study was to assess the feasibility of a porcine model for free-flap breast reconstruction. Three female pigs were placed under general anesthesia in order to study feasibility and estimate relevance for training. The deep inferior epigastric perforator (DIEP) flap, the transverse musculocutaneous gracilis (TMG) flap, and the superior gluteal artery perforator (SGAP) flap were harvested and anastomosed to the internal thoracic vessels. Differences were noted between pig and human anatomy, and the surgical procedure was adapted to build training models. Under a more prominent anterior thoracic wall, the internal thoracic vessels were slightly deeper and larger than in human anatomy. The DIEP flap was never feasible in the porcine model. However, the superior epigastric artery perforator (SEAP) flap showed anatomical similarity with the human DIEP flap, and it proved to be suitable for an inverted training model. The porcine TMG flap harvesting was close to the human one, reproducing specific dissection and anastomotic difficulties. The SGAP flap was not a muscular perforator flap in pigs but a septocutaneous flap. Because of the thinness of the hypodermal fat, porcine flaps were not considered adequate training models for breast-mound shaping. Despite any anatomical variations, the pig has proven to be a suitable training model for free-flap harvesting and transfer in the field of breast reconstruction.

Superior epigastric artery perforator (SEAP) flap: A novel approach to autologous breast reconstruction

Although free tissue breast reconstruction has been increasingly used, it remains challenging to perform outside of specialized centers due to facility and personnel limitations. We describe a preclinical study highlighting the feasibility of a pedicled, superior epigastric artery perforator (SEAP) flap utilizing lower abdominal tissues similar to a transverse rectus abdominus myocutaneous (TRAM) reconstruction, but with decreased donor-site morbidity. Fresh cadavers were dissected generating a total of 32 SEAP flaps. These flaps were subsequently studied for transposition potential and vascularity utilizing computed tomographic (CT) imaging. An obvious, single, dominant SEAP was appreciated, and a developed flap was routinely capable of reaching either nipple-areola complex with simple interposition. Cadaveric CT imaging revealed global contrast filling in each dissected hemi-abdomen tested. We describe a preclinical study utilizing a novel pedicled, SEAP flap for aesthetic breast reconstruction. While this will not obviate the use of free tissue transfer, it may add to the surgical armamentarium for aesthetic restoration in the breast cancer patient.

Superior epigastric artery perforator flap: anatomy, clinical applications, and review of literature.

To reduce donor site morbidity in anterior chest wall reconstruction, a flap based on perforators of the superior epigastric artery (SEA) was developed and successfully applied in a pedicled fashion for locoregional soft-tissue reconstruction. We combined our anatomical and clinical experience with superior epigastric artery perforator (SEAP) flap with a PubMed search of the English language literature for articles published on "SEAP flap". Reference lists of the articles found were then checked for other related articles of interest. Articles were compared looking at flap indication, preoperative imaging, perforator morphology, SEA integument area, surgical approach, and outcome of the flaps. The four best perforators were most frequently encountered in an area 2 to 6 cm from the midline and 0 to 10 cm below the xiphoid process. The territory of the SEAPs depends on the location of the perforator. Controversy exists in the current literature concerning preferable SEAP flap orientation. Although tip necrosis is the major complication, this can often be treated conservatively without affecting outcomes or can even be avoided by limiting flap length to the anterior axillary line and the zone below the midpoint between the xiphisternum and the umbilicus. The SEAP flap provides a useful approach for reconstruction of defects of the anterior chest, or of the abdominal wall. As a perforator or adipocutaneous flap, the flap is reliable and easy to raise, and spares donor site morbidity.

Superior epigastric artery perforator flap for sternal osteomyelitis defect reconstruction

Sternal osteomyelitis after median sternotomy is associated with considerable morbidity and mortality. Combined with radical debridement, muscle and less frequently omentum flaps are used to reconstruct the resulting defects. In this study, we present our experience with the fasciocutaneous superior epigastric artery perforator (SEAP) flap for defect closure. After resection of the entire sternum, including the costochondral arches and the sternoclavicular joints, the repair of the defect was performed with the perforator flap without any re-stabilisation of the thoracic wall. A consecutive series of nine patients with a mean age of 69 ± 6 years were reconstructed with the SEAP flap. The mortality rate was zero. One patient developed a mediastinal haematoma and required five re-interventions by the cardiothoracic surgeons and thereafter a revision to close a small-wound dehiscence at the tip of the flap. Another two patients developed partial necrosis of the flap that could be managed conservatively. One patient had a revision for a seroma on the donor site, resulting in a 100% closure rate of the defect; there were revisions in two out of nine patients. The underlying infection was controlled by debridement, antibiotic therapy and flap closure in all cases. The overall success of the procedure was satisfactory; however, the local complication rate was relatively high with three out of nine patients on the flap side and one of nine on the donor site. Major advantages of the perforator flap in this highly morbid patient cohort are that the operation is relatively quick, muscle tissue is spared and re-education facilitated.

Perforasomes of the upper abdomen: An anatomical study

Pedicled perforator flaps in the trunk such as the DIEAP or the IMAP-flap have increasingly been used for reconstructive purposes. However, perforator flaps of the upper abdominal wall derived from the SEA and DIEA have not been widely reported in literature. The aim of this study was to investigate the vascular basis of perforator flaps of the upper abdominal wall based on the epigastric vascular axis and to describe the location and size of the individual flaps. The superior and deep inferior epigastric artery perforators (SEAPs and DIEAPs) of the supraumbilical abdominal wall of ten fresh anatomical specimens were selectively injected with Methylene blue solution or India ink. The location and size of the labeled skin area was observed. Finally, the arterial perforators were dissected and the length, diameter and the distance of the perforation point to the midline, xiphoid process and umbilicus were recorded. The SEAPs and DIEAPs supplied the ventromedial skin of the lower thoracic and supraumbilical abdominal wall in a sequential order. The mean size of all injected skin areas was 65 ± 31.4 cm(2) (10.2 × 8.8 cm). A mean number of 9.7 ± 4.2 perforators per specimen was identified. The mean external diameter of the dissected perforators was 0.82 ± 0.32 mm. The perforator length until arborization averaged 3.44 ± 1.07 cm. Most perforators were located in an area 2-6 cm from the midline and 0-10 cm below the xiphoid process. Through selective injection of perforators, a reliable anatomy of SEAP- and DIEAP-flaps of the upper abdominal wall could be demonstrated. From a clinical point of view, subcostal SEAP-flaps are of special interest. These flaps may be rotated cranially for lower chest wall or breast reconstruction or deflected caudally for abdominal wall reconstructive purposes. The harvest site can be closed directly or via a reverse abdominoplasty procedure.

The vascular basis of perforator flaps of the upper abdominal wall: an anatomical study

IntroductionPedicled perforator flaps in the trunk such as the DIEAP (deep inferior epigastric artery perforator) flap have increasingly been used for reconstructive purposes. However perforator flaps of the upper abdominal wall derived from the SEA (superior epigastric artery) and DIEA have not been widely reported. The aim of this study was to investigate the vascular basis of perforator flaps of the upper abdominal wall based on the epigastric vascular axis and to describe the location and size of the individual flaps.Material and MethodsThe superior and deep inferior epigastric artery perforators of the supraumbilical abdominal wall of ten fresh cadavers were injected with methylene blue solution or india ink. The location and size of the labelled skin area was observed. The arterial perforators were dissected and the length, diameter and the distance of the midline, xiphoid process and umbilicus to the perforation point was recorded.ResultsThe SEAPs and DIEAPs supplied the ventromedial skin of the lower thoracic and supraumbilical abdominal wall in a sequential order. The mean size of all injected skin areas was 65,8 ± 33,7 cm2 (9,9 × 8,8 cm). A mean number of 9,8 ± 4,2 perforators was identified. The mean external diameter of the dissected perforators was 0,8 ± 0,3 mm (range 0,5 – 1,9 mm). The perforator length until arborisation averaged 3,6 ± 1,1 cm (range 2 – 7 cm). Most Perforators were located in an area 4–6 cm from the midline and 5–10 cm below the xiphoid process.ConclusionsA reliable anatomy of SEAP and DIEAP flaps of the upper abdominal wall could be demonstrated. Especially subcostal SEAP flaps are of clinical interest. These flaps may be rotated cranially for lower chest wall reconstruction or deflected caudally for abdominal wall reconstructive purposes. The harvest site could be closed directly or via a reverse abdominoplasty procedure.Grant Funding Source: AAA