Venous perforators in DIEAP flaps: An observational anatomical study using duplex ultrasonography * Andrea Figus a, *, Ryckie G. Wade a , Louise Gorton a , Corrado Rubino b , Matthew G. Griffiths a , Venkat V. Ramakrishnan a a St Andrew’s Centre for Plastic Surgery and Burns, Chelmsford, UK b University of Sassari, Department of Plastic Surgery, Sassari, Italy Received 27 November 2011; accepted 29 February 2012 KEYWORDS Duplex; Perforator; Doppler; DIEAP; DIEP; SIEA; SIEV; Breast; Reconstruction Summary Background: The DIEAP flap has gained popularity for breast reconstruction world- wide. Despite DIEAP flap arterial anatomy being well known, venous congestion is still an important complication and the literature on DIEAP flap venous anatomy is lacking. Venous drainage is less predictable and research on venous perforators is of increasing interest. The aim of this study was to investigate the anatomical distribution, diameters and relationships between arterial and venous perforators and their source vessels using Duplex ultrasonog- raphy, in order to evaluate the potential benefits of pre-operative evaluation of DIEAP flap venous perforators. Methods: Prospectively, 140 patients undergoing DIEAP flap breast reconstruction, were pre- operatively assessed using Duplex ultrasonography for location and diameter of arterial and venous perforators, DIEA, DIEV, and SIEV. Perforators were plotted laterally and inferiorly from the umbilicus. Means were compared using t-tests. Pearson’s correlation coefficients were calculated. Results: We identified 702 arterial and 355 venous perforators in 280 lower hemi-abdomens. No venous perforators were identified in 9 (6.5%) patients; none on the right in 25 (17.9%) and none on the left in 36 (25.7%). Venous perforators were larger on the right (p Z 0.031) but DIEV and SIEV diameters were not statistically different on either sides. The diameters of DIEA, DIEV, perforating arteries and veins were correlated, but unrelated to the diameter of the SIEV. When a medium/large perforator vein is identified first, there is a 93.5% chance of finding an associated medium/large perforator artery; this reduces to 69.8% when a medium/large perforator artery is first identified. * This paper has been presented in part at the 12th Annual International Perforator Course, Coimbatore, India, September 10e13, 2008, and in its final version at the Annual Winter Meeting of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), London, UK, December 1e3, 2010 and at the 22nd Annual Meeting of the European Association of Plastic Surgeons (EURAPS), Mykonos, Greece, June 2e4, 2011. * Corresponding author. Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich Medical School, University of East Anglia, Colney Lane, Norwich, Norfolk NR4 7UY, United Kingdom. E-mail address: andreafigus@hotmail.com (A. Figus). 1748-6815/$ - see front matter ª 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2012.02.026 Journal of Plastic, Reconstructive & Aesthetic Surgery (2012) 65, 1051e1059