Arch Hand Microsurg 2018; 23(4): 281-289  
Classification of Deep Inferior Epigastric Perforator Courses Based on Computed Tomography Angiography: Incidences and Clinical Implications
Yeonhoon Lee1, Sung Chan Kim2, Jin Sup Eom1, Eun Key Kim1
1Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Woori Plastic Surgery Clinic, Seoul, Korea
Correspondence to: Eun Key Kim
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
TEL: +82-2-3010-3600, FAX: +82-2-476-7471, E-mail:
Received: July 25, 2018; Revised: September 11, 2018; Accepted: September 17, 2018; Published online: December 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Purpose: Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning.
Methods: The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated.
Results: A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen.
Conclusion: Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.
Keywords: Breast reconstruction, Perforator flaps, Computed tomography angiography

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