FLAP RECONSTRUCTION SURGERY (AUTOLOGOUS RECONSTRUCTION) DEEP INFERIOR EPIGASTRIC ARTERY PERFORATOR FLAP

The lower abdominal flaps are considered the gold standard in autologous tissue breast reconstruction due to the volume and amount of skin they provide. The deep inferior epigastric perforator (DIEP) flap, which preserves the abdominal wall muscles, provides tissue from the lower abdomen while min-imizing the risks of hernia and bulging. Cadaveric studies conducted to identify the perfusion zones of DIEP flaps demonstrate that zones may vary depending on the selected perforator. Accordingly, the area supplied by the medial perforator extends across the midline, creating a pattern more similar to Hartrampf’s description, whereas the area supplied by the lateral perforators rarely crosses the midline. Preoperative CT angiography is crucial for surgical planning. Using CT angiography, the largest per-forator around the umbilicus can be identified. Patient marking should be performed with the patient in a standing position. The lower incision should be placed in the suprapubic region, and the upper incision should be planned just above the umbilicus and positioned to ensure closure is feasible when pinched manually.