Primary Blood Supply to Fasciocutaneous Trunk Flap of the Abdomen

Vascular Anatomy of Abdominal Fasciocutaneous Flaps

The American College of Radiology recommends that the deep inferior epigastric artery (DIEA) is the main source vessel providing blood supply to the lower abdominal wall through its perforator branches, which arise from the external iliac artery 1, 3
The DIEA has a consistent origin from the external iliac artery, making this vessel reliably identifiable 4
The perforator branches of the DIEA can be classified into three types based on their branching pattern: single trunk (type 1), bifurcating trunk (type 2), and trifurcating trunk (type 3) 1
These perforator arteries are further divided into intramuscular, subfascial, and subcutaneous segments as they course through the abdominal wall 1

Preoperative imaging (CT angiography or MR angiography) is recommended to map the perforators and their branches, leading to reduced operative time and increased flap reliability 1, 4
Understanding the perforator anatomy helps in selecting the "best" perforator based on size, location, and intramuscular course 1
A short intramuscular course allows for successful dissection of the perforator 1
The ideal perforator should be of large caliber and medially located within the flap with an extended vascular territory beyond the midline to provide optimal perfusion 4