From the Guidelines
The vessels most at risk of injury during rectus muscle flap reconstruction post mastectomy are the deep inferior epigastric vessels, specifically the deep inferior epigastric artery (DIEA) and its perforators, as they are crucial for the blood supply to the rectus abdominis muscle flap 1. When considering the anatomy involved in rectus muscle flap reconstruction, it's essential to understand that the primary blood supply to the flap comes from the deep inferior epigastric vessels. The DIEA, which arises from the external iliac artery, provides the main arterial supply to the rectus abdominis muscle through its perforators 1.
Key Vessels at Risk
- Deep inferior epigastric artery (DIEA) and its perforators: These are the primary vessels at risk due to their critical role in supplying blood to the rectus abdominis muscle flap 1.
- Superior epigastric vessels: Although less directly involved in the blood supply to the flap, these vessels can be injured, particularly at the superior aspect of the muscle where they enter the rectus.
- Perforating vessels: Connecting the deep system to the overlying skin and subcutaneous tissue, these vessels are vulnerable during flap elevation.
- Intercostal vessels: Near the lateral border of the rectus sheath, these vessels may be damaged during lateral dissection.
- Thoracodorsal vessels: At risk when connecting the flap to the chest wall vasculature.
Importance of Preoperative Imaging
Preoperative imaging, such as CT angiography (CTA) or MR angiography (MRA), plays a crucial role in identifying the variable anatomy of the perforators and selecting the ideal perforator for the procedure 1. This imaging helps in reducing operative time, minimizing donor site morbidity, and increasing flap reliability by accurately mapping the perforators and their branches.
Surgical Considerations
Careful identification and preservation of these vascular structures are essential for successful outcomes in rectus muscle flap reconstruction. The selection of the "best" perforator, based on size, location, and intramuscular course, is critical for flap viability and minimizing complications such as fat necrosis and loss of function at the donor site 1.
From the Research
Vessels at Risk of Injury during Rectus Muscle Flap Reconstruction
The vessels at risk of injury during rectus muscle flap reconstruction post mastectomy include:
- Inferior Epigastric Artery: This artery is closely related to the rectus abdominis muscle and is often used as a pedicle for breast reconstruction flaps, such as the deep inferior epigastric artery perforator (DIEP) flap 2, 3, 4.
- Superior Epigastric Artery: Although not directly mentioned in the context of rectus muscle flap reconstruction, the superior epigastric artery is another vessel that could be at risk of injury during surgical procedures in the abdominal region.
Considerations for Vessel Injury
It is essential to consider the anatomy and variability of the inferior epigastric artery and its perforators when performing rectus muscle flap reconstruction 2, 3, 4. The use of alternative flaps, such as those based on the superficial inferior epigastric artery, may also be considered to minimize donor-site morbidity 3, 4. Additionally, the choice of flap type, such as the transverse rectus abdominus myocutaneous (TRAM) or DIEP flap, may impact the risk of vessel injury and other complications 5.