The deep inferior epigastric artery free skin flap: anatomic study and clinical application

We carried out an anatomic study to create the efficient surgical technique of elevating the inferior epigastric artery free skin flap. The deep inferior epigastric artery bifurcates into the lateral and medial branches. The former usually is larger in diameter and has many skin perforators slightly lateral to the midline of musculature. When a vascular pedicle skin flap is lifted without attaching the rectus abdominis muscle or its anterior sheath, it seems more efficient if the flap uses the skin perforator belonging to the lateral branch. This is so because entry of the inferior epigastric artery is from the lateral side of the rectus abdominis muscle and the lateral branch runs slightly lateral to the midline of the musculature and parallel to the run of the muscular fibers. This would be easier technically and would minimize the damage to the muscle when detaching the lateral branch.