The lymphatic system of the deep inferior epigastric artery perforator flap: an anatomical study

The anatomical basis of the lymphatic system of the deep inferior epigastric perforator (DIEP) flap was studied in 24 abdominoplasty specimens and in three fresh cadavers. Methylene (n = 4), patent (n = 4) and Turnbull's (n = 8) blue were compared by injecting the dye intradermally. To facilitate staining, two different types of vacuum technique were used: a vacuum chamber (n = 4) and the vacuum-assisted method (n = 4). The lymphatic collectors were dissected, and embedded in paraffin for histological investigation. The most useful dye was Turnbull's blue. The vacuum had no effect on the distribution of the dye. Manual injection showed three parallel superficial collectors situated directly under the skin. Turnbull's blue was also injected into the rectus fascia to demonstrate the collectors of the deep abdominal structures. They run horizontally, and perforate the fascia to run with the inferior epigastric artery. Care should be taken when dissecting the pedicle, or removing the epithelium, to avoid destroying the lymphatic system of the flap.