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Anatomy of Superficial Inferior Epigastric Vessels: Revival of Superficial Inferior Epigastric (SIEA) Flap
Suphalerk Lohasammakul, M.D.1, Chairat Turbpaiboon, MD, PhD2, Visnu Lohsiriwat, M.D.3, Kongkrit Chaiyasate, MD, FACS4, Rosarin Ratanalekha, MD2, Apirag Chuangsuwanich, MD1.
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Division of Head-Neck and Breast Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 4Division of Plastic Surgery, Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.

Abstract
Purpose: Development of perforator flaps evolve the perspective of reconstructive surgery to another level due to many of their advantages over the pedicled flaps particularly lower donor-site morbidity and versatility in flap design. Superficial inferior epigastric artery (SIEA) flap, as a perforator flap, offers this significant advantage over other lower abdominal flaps due to no required dissection of rectus abdominis muscle. However, both vascular agenesis and inappropriate vessel size for anastomosis are the major limitations of SIEA. This study was therefore aimed to investigate these aspects of this vessel.
Methods: Twenty embalmed cadavers were dissected bilaterally to demonstrate vascular anatomy of these vessels.
Results: SIEA agenesis rate is only 7.5%. Its diameters greater than 1 mm and 1.5 mm were found up to 86% and 30%, respectively. The distance between its origin and point of entering Scarpa’s fascia varies from 10.29 to 62.62 mm (mean 37.48 mm). On the contrary, vein exists in all dissections with diameter varying from 2.12 to 5 mm (mean 3.09 mm) and the distance as measured in SIEA varying from 20.1 to 74.28 mm (mean 41.24 mm). SIEA mostly crosses inguinal ligament within area between mid-inguinal point and 3 cm medially. Correlations were found (1) between SIEA diameter and pedicle length and (2) between bilateral pedicle lengths of both artery and vein.
Conclusions: High prevalences of both SIEA existence and SIEA with surgically sufficient diameter observed from this study makes this vessel worth being considered as appropriate choice in reconstructive treatment.


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