Anatomy of the Superficial Inferior Epigastric Artery Flap

Background: Several case studies have described the use of the superficial inferior epigastric artery (SIEA) flap as a pedicled flap for reconstruction of upper and lower ex tremities, or a free fasciocutaneous flap when a large amount of skin coverage is required for hemifacial atrophy, breast or head and neck reconstruction. Apparently, the anatomical findings of previous studies are relatively discrepant. This study was designed to describe the anatomical variations of SIEA and superficial inferior epigastric vein (SIEV).
Methods: A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site of origin and drainage of vessels, caliber, length, and correlation between diameter and length of pedicle were identified.
Results: The SIEA and SIEV were identified at the inguinal ligament level in 38 (95%) and 40 (100%) dissections, respectively. The SIEA originated directly from the common femoral artery in 22 (57.9%) or as a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The mean±SD length of SIEA was 3.04±1.73 (0.5- 7) cm. The mean±SD caliber of SIEA was 1.45±0.35 (0.7- 2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a mean±SD of 5.45±2.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a mean±SD of 2.14±.45 mm. The length of SIEA correlated with caliber of the arterial pedicle (p<0.001 and correlation coefficient = 0.517).
Conclusion: This study suggests that the SIEA flap can be applied for micro surgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required.