Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap

The anatomical basis of the blood supply to the deep inferior epigastric perforator (DIEP) flap and the circulation of the cutaneous territory zone IV have been studied in 40 anatomical dissections on fresh cadavers. The pedicle length, diameter and the number and distribution of the major perforator vessels were recorded. The cutaneous territories supplied by the perforator vessels were studied by injecting blue dye in the pedicle of ten specimens. In addition, intravital blue dye studies were performed by injecting the largest perforating vessel of five patients at abdominoplasty. The resulting cutaneous staining was recorded. The deep inferior epigastric artery was present in all cadaver dissections with an average length of 10.3 cm (range 9.0–13 cm) and an average diameter of 3.6 mm (range 2.8–5.0 mm). There were consistently one or two major perforator vessels for each pedicle, located within a radius of 8 cm below the umbilicus. The results of the injection study revealed cutaneous staining of zones I–III. Zone IV was stained weakly or not at all. The same findings were obtained in the clinical cases of abdominoplasty. Zone IV must be critically assessed in clinical cases of the DIEP flap.