Superior Epigastric Artery Perforator Flap for Chest and Abdominal Reconstruction: Anatomical Study and Clinical Application.

Background: Tissue flaps based on the superior epigastric artery (SEA) and its perforators have been described previously. We present a study of the perforators of the SEA with anatomical cadaveric studies, clinical applications, and vessel imaging. The SEA perforator emerges just below the margin of the rib cage and supplies the skin transversely, making it a strong choice for locoregional chest and abdominal wall reconstruction. This flap offers reduced donor site morbidity by sparing the fascia, rectus abdominis, and lateral oblique muscles. This study presented an SEA perforator flap using anatomical and clinical studies. Methods: Aqueous contrast was injected into the internal thoracic arteries of 35 fresh cadavers. A total of 114 SEA perforators were dissected (62 right, 52 left), with vessel caliber and location noted on x-y axes. After achieving a reproducible technique, 5 patients underwent chest wall reconstruction and 1 underwent abdominal wall reconstruction using SEA perforator-based flaps. Results: The mean arterial caliber of SEA perforators was 0.68 mm (SD = 0.31 mm), with an average location of 2.66 cm in the x direction and 4.9 cm in the y direction (xiphoid process = (0,0)). No significant differences in vessel caliber or location were observed between sides. In clinical cases, donor site dimensions averaged 19.3 × 7.2 cm, and primary closure of donor sites resulted in no major complications. Conclusions: Flaps based on SEA perforators are versatile, reliable, and reproducible; thus, they represent a strong choice for chest and abdominal wall reconstructions.