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Mapping the Superficial Inferior Epigastric System and Its Connection to the Deep System: An MRA Analysis
David E. Kurlander, Matthew Brown, Rodrigo A. Iglesias, Hooman T. Soltanian
University Hospital Case Medical Center
2014-02-28
Presenter: David Kurlander
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The project was conceived by the senior author with data collection and analysis by the resident and medical students.
Director Name: Hooman Soltanian
Author Category: Medical Student
Abstract Category: Breast (Aesthetic and Recon.)
BACKGROUND: Flaps based on superficial inferior epigastric artery are ideal for their minimal donor site morbidity and large adipocuntaneous bulk. However, the anatomy in terms of branching patterns, interaction with the deep inferior epigastric system, and left/right communications are poorly characterized.
METHODS: Preoperative imaging from all patients undergoing free flap breast reconstruction by a single surgeon (HTS) from 2008-2013 was examined. Patients receiving abdominal magnetic resonance angiogram (MRA) were included for analysis. The main artery and primary and secondary branches from each patient's superficial inferior epigastric system were drawn onto a coordinate system, and branching patterns were categorized as bilateral connection, unilateral-simple, and unilateral complex. Numbers of deep-superficial inferior epigastric connections, trifurcations, and total branches were recorded.
RESULTS: Sixty patients were identified, with 46 included for analysis. Fourteen patients (30.0%) had at least one left-right superficial inferior epigastric connection. Mean number of deep-superficial connections per patient was 2.1, with all but 5 patients having at least 1 such total connection. Mean number of branches on the left was 2.3 and right was 2.7. Thirteen patients (28.2%) had at least one trifurcation.
CONCLUSIONS: The finding that 30% of viewed MRA had visible connections crossing the abdomen within the superficial system suggests lateralized vascularization compared to the deep system. Additionally, knowing that left/right superficial inferior epigastric connections and connections to the deep inferior epigastric system are not uncommon and may increase confidence in the venous drainage and perfusion of these flaps.
