The largest perforator of DIEP flap has a higher rate of continuity with the superficial inferior epigastric artery.

[BACKGROUND] In deep inferior epigastric artery (DIEA) perforator (DIEP) flap breast reconstruction, the network with the superficial inferior epigastric artery (SIEA) is key to achieving stable subcutaneous blood flow to the flap. This study investigated how the diameter and location of the DIEA perforator affect continuity with the SIEA.

[METHODS] A retrospective analysis of 94 specimens from 47 patients who underwent DIEA perforator flap breast reconstruction was performed. Relationships between the diameter and location of the DIEA perforator and its continuity with the SIEA were examined on preoperative multi-slice computed tomography.

[RESULTS] The largest DIEA perforator on each specimen showed continuity with the SIEA in 94 %, significantly more than the second (80 %; p = 0.027) or third largest perforator (76 %; p = 0.005). Medial perforators from 3 cm above to 3 cm below the umbilicus showed more continuity with the SIEA than lateral perforators (p = 0.008).

[CONCLUSIONS] Selection of the largest perforator of DIEP flap is advantageous in terms of continuity with the SIEA. Also, near the umbilicus, medial perforators communicate with the SIEA more than lateral perforators.