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J Reconstr Microsurg 2010; 26(6): 381-389
DOI: 10.1055/s-0030-1249604
© Thieme Medical Publishers

Anatomical and Technical Tips for Use of the Superficial Inferior Epigastric Artery (SIEA) Flap in Breast Reconstructive Surgery

Amir H. Dorafshar1 , Michael Januszyk1 , 2 , David H. Song1
  • 1Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, Illinois
  • 2Department of Surgery, Stanford University School of Medicine, Stanford, California
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Publication History

Publication Date:
18 March 2010 (online)

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ABSTRACT

Techniques for autologous breast reconstruction have evolved to minimize donor-site morbidity and reduce flap-specific complications. When available, the superficial inferior epigastric artery (SIEA) flap represents the optimal method to achieve the former. However, many microsurgeons have been reluctant to adopt this procedure due to technical challenges inherent to the surgery, as well as concerns with the intrinsic capacity of the superficial vessel system to adequately support this flap. This article sets forth a simple approach to the SIEA flap harvest and demonstrates that favorable results may be achieved even for small caliber vessels. A total of 46 patients underwent 53 SIEA breast reconstructions over a 6-year period using a modified approach for pedicle dissection and arterial inclusion criteria solely on the basis of presence of a palpable pulse. Average pedicle length harvested for all SIEA flaps was 6.07 cm; and mean arterial (0.96 mm) and venous (2.27 mm) diameters represent the lowest published values. Three flaps (5.7%) demonstrated fat necrosis or partial flap necrosis, with one (1.9%) complete flap loss. These results compare favorably with those of previous SIEA series employing diameter-based selection criteria, suggesting that the presence of a palpable arterial pulse may be sufficient to permit successful utilization of this flap.

KEYWORDS

Superficial inferior epigastric artery - breast reconstruction - perforator flap

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David H SongM.D. M.B.A. 

Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center

5841 S. Maryland Ave., MC 6035 Chicago, IL 60637

Email: dsong@surgery.bsd.uchicago.edu