Feasibility and Safety of Using Perforators Through Tendinous Intersections of the Rectus Abdominis for DIEP Flap Breast Reconstruction: A Retrospective Study.

Background: The deep inferior epigastric perforator (DIEP) flap technique has gained popularity due to its muscle-sparing properties, significantly reducing morbidity and enhancing aesthetic outcomes in breast reconstruction. In a considerable number of patients, dominant perforators traverse tendinous intersections (TI) of the rectus abdominis muscle, referred to as intra-TI perforators (ITIP). Our study pursued two principal objectives: to determine the accuracy of preoperative computed tomography angiography (CTA) in identifying ITIP and to evaluate whether utilizing ITIP in DIEP flap harvest impacts flap perfusion or elevates the incidence of donor-site complications.

Methods: We conducted a retrospective analysis of 81 DIEP flaps from 54 female patients between 2022 and 2024. Patients were categorized into ITIP and NTIP groups based on the anatomical location of the dominant perforator. Preoperative CTA was used to identify perforator course. Intraoperatively, dissection time was recorded. Flap perfusion was quantitatively assessed using fluorescence imaging, and postoperative complications were monitored for 6 months.

Results: In this retrospective study, we found that although ITIP required longer dissection time, they provided reliable perfusion without increasing complication rates. Maximum correlation analysis found that the y-axis distance of ITIP had the strongest correlation with the dissection time.

Conclusion: ITIP flaps appreciate sufficient blood perfusion compared with NTIP flaps, and the incidence of complications is not increased, making it a feasible candidate for DIEP breast reconstruction.

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