How long are fasciocutaneous flaps dependant on their vascular pedicle: A unique case of SIEA flap survival Morteza Enajat a,1 , Warren M. Rozen b,2 , Iain S. Whitaker c , Thorir Audolfsson a,1 , Rafael Acosta a, * a Department of Plastic Surgery, Uppsala Clinic Hospital, Uppsala 75185, Sweden b Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, The University of Melbourne, Grattan Street, Parkville, 3050 Victoria, Australia c Department of Plastic, Reconstructive and Burns Surgery, The Welsh National Plastic Surgery Unit, The Morriston Hospital, Swansea, UK Received 5 September 2008; accepted 10 March 2009 KEYWORDS Breast reconstruction; Perforator flap; DIEP flap; Vascular pedicle; Dominant; Blood supply Summary Background: While it has long been held that muscle flaps maintain their dependency on their vascular pedicle for the long term, fasciocutaneous flaps have been less well investigated. Recent studies of the deep inferior epigastric artery perforator (DIEP) flap have suggested that these flaps may maintain long term dependence on their vascular pedicles for survival. There is no litera- ture concerning these effects in the superficial inferior epigastric artery (SIEA) flap. Case report: We describe a unique case in which the pedicle of a superficial inferior epigastric artery (SIEA) flap for breast reconstruction was avulsed 11 days postoperatively, with the flap surviving on its inferior wound edge alone. Conclusion: Fasciocutaneous flaps may lose dependency on their vascular pedicles in the short term following transfer, developing alternative pathways for vascular supply and ultimately survival. A conservative approach early in the course of flap compromise due to perforator ligation or avulsion, in cases where immediate re-anastomosis may not be feasible, is thus supported. ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. * Corresponding author. Tel.: þ46 18611 0000. E-mail addresses: m.enajat@live.nl (M. Enajat), warrenrozen@hotmail.com (W.M. Rozen), iainwhitaker@fastmail.fm (I.S. Whitaker), thorir.audolfsson@akademiska.se (T. Audolfsson), rafael.acosta.rojas@akademiska.se (R. Acosta). 1 Tel.: þ46 18611 0000. 2 Tel.: þ613 9347 5939. 1748-6815/$ - see front matter ª 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2009.03.009 Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, e347ee350