[Reconstruction of Perineal and Pelvic Defects: the Inferior Epigastric Artery (DIEA) as a Recipient Vessel for Free Flap Reconstruction].

Abstract

Extensive defects in the perineal or anterior/lateral pelvic region can occur as a result of tumour-related resections, infections, or postoperative complications. In cases where local or pedicled flap reconstructions are insufficient, microsurgical reconstruction using free flaps becomes necessary. Due to its location and calibre, the inferior epigastric artery (DIEA) is a suitable recipient vessel for microsurgical tissue transfer.In a retrospective case study conducted between June 2024 and March 2025, patients with perineal or pelvic defects underwent microsurgical reconstruction. Defect coverage was achieved using free flap techniques (musculocutaneous vastus lateralis [MVL], musculocutaneous latissimus dorsi [LD] and parascapular flaps) with end-to-end anastomosis to the DIEA. Preoperative planning included CT angiography to assess the vascular situation. Microsurgical anastomoses were performed in a standardised manner, with arterial anastomoses hand-sewn and venous anastomoses carried out using venous couplers. The perfusion of the anastomoses and the flap was assessed using ICG fluorescence. Postoperative care included structured offloading and mobilisation.During the study period, five patients (average age 64.6 years, ASA score 2.8) with perineal or pelvic defects averaging 413.4 cm² were treated. The underlying causes were tumours (3) and extensive infections (2). The DIEA was successfully used as a reliable recipient vessel in all cases. Venous anastomoses were performed using venous couplers with an average diameter of 2.5 mm (range: 2-3 mm). No flap losses or necroses occurred.The results confirm the suitability of the DIEA as a consistent, superficial, and easily dissectible recipient vessel with stable calibre and sufficient flow, even for large flaps. It enables safe microsurgical reconstructions in the anterior and lateral pelvic region and represents a valid alternative to the femoral artery, without compromising extremity perfusion. The study highlights the significant role of the DIEA in plastic and reconstructive surgery of complex pelvic and perineal defects.