No abstract available.
Epigastric Arteries* ; Rectus Abdominis* ; Skin*

Flap thinning is a procedure for making a thick flap thinner. This procedure does more than simply fill in the defected area, and it is better for reconstructing the area both functionally and aesthetically. However, because flap thinning is a rather blind procedure, it may have harmful effects on flap vascularity. Therefore, the vasculature of a flap must be understood before performing flap thinning. This paper analyzes the basic anatomy underlying flap thinning based on the previous anatomic study that categorized flaps into 6 types by their vascular structures. This paper also reviews specific studies of frequently practiced flap procedures (deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, and anterolateral thigh flap) and presents important precautions for flap thinning procedures. Finally, this paper briefly examines the axiality of the subdermal plexus, which needs to be taken into account when performing flap thinning.
Arteries ; Epigastric Arteries ; Perforator Flap ; Thigh

We studied the distribution patterns of perforating branch of superficial circumflex iliac artery for flap surgery in Korean. Fifty one thighs from 34 Korean cadavers (17 males/ 17 females) were dissected and standard points were determined as follows: point of anterior superior iliac spine (A), point of pubic tubercle (B), cross point of the line AB and femoral artery (FA), cross point of the femoral artery and the sartorius muscle (FAS), beginning point of superficial circumflex iliac artery (O), and perforating point of superficial circumflex iliac artery (P). We measured the distance and the angles between the standard points. Each frequency of superficial circumflex iliac artery from femoral artery and superficial epigastric artery is 69.6% and 30.4% respectively. The mean distance between the beginning point of superficial circumflex iliac artery (O) and the point A was 7.3+/-1.3 cm and the mean distance between the point O and the point B was 5.7+/-0.6 cm. The angle from line OA to line AB was 17.9+/-8.0 degrees and The angle from line OB to the line AB was 24.9+/-5.1 degrees. The mean distance between the perforating point for superficial circumflex iliac artery (P) and the point A was 6.3+/-2.4 cm and the mean distance between the point P and the point B was 8.3+/-2.7 cm. The angle from line PA to line AB was 33.4+/-18.3 degrees and the angle from line PB to the line AB was 24.5+/-14.3 degrees. Consequently, the pattern of distribution of superficial circumflex iliac arteries, obtained in this study, will provide useful anatomical backgrounds for the superficial circumflex iliac artery flap surgery in Korean.
Cadaver ; Epigastric Arteries ; Femoral Artery ; Iliac Artery* ; Spine ; Thigh

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.
Abdominal Cavity ; Arteries ; Coronary Artery Bypass ; Epigastric Arteries ; Forearm ; Gastroepiploic Artery ; Radial Artery ; Saphenous Vein ; Spasm

This is the third in a series on coronary artery bypass which reviews three alternative arterial conduits. The radial artery has become the most widely used of the three and accumulating experience demonstrates better patency at 10 years versus saphenous vein. Drawbacks are a long incision on the forearm, the propensity for spasm and persistent sensory disturbance in about 10%. The first is answered by endoscopic harvest which may yield a shorter conduit but reduces sensory nerve injury. Spasm is managed pharmacologically and by less harvest trauma. The gastroepiploic artery is used in situ and free and although the abdominal cavity is entered complications are minimal and patency compares favorably with the radial artery. Use of the inferior epigastric artery remains minimal and its similar length often requires composite use but limited patency data are supportive. Other arteries have had rare use and this is unlikely to change because the three presented here have significant advantages and acceptance.
Abdominal Cavity ; Arteries ; Coronary Artery Bypass ; Epigastric Arteries ; Forearm ; Gastroepiploic Artery ; Radial Artery ; Saphenous Vein ; Spasm

BACKGROUND: A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. METHODS: We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. RESULTS: The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%+/-9.76%, 37.01%+/-9.21%, and 35.42%+/-9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%+/-5.64%, 52.30%+/-2.88%, and 47.87%+/-6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%+/-7.15%. CONCLUSIONS: These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery.
Arteries ; Cadaver ; Epigastric Arteries ; Humans ; Latex ; Microsurgery ; Microvessels ; Perforator Flap* ; Subcutaneous Fat ; Surgical Flaps ; Thigh

PURPOSE: We report the results of a penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery in arteriogenic impotent patients. MATERIALS AND METHODS: Microvascular arterial bypass surgery was performed in 5 impotent patients (age 29-40, mean 35 years) in order to treat a cavernosal arterial insufficiency secondary to focal occlusive disease in cavernosal arteries. The surgical procedure was performed on an end-to-side anastomosis of the inferior epigastric artery to the dorsal penile artery. The erectile function was evaluated by the International Index of the Erectile Function questionnaire (IIEF) and penile duplex Doppler ultrasonography before and 6 weeks after surgery. RESULTS: The IIEF score improved in 4 of 5 patients postoperatively. Penile arterial peak systolic velocity (PSV) had improved significantly from 21.4+/-2.2cm/sec to 33.7+/-9.6cm/sec in the right side, from 18.5+/-6.8cm/sec to 36.0+/-10.0cm/sec in the left (p< 0.05), respectively. There were no serious adverse effects of the surgery except for one patient who had a hematoma at the vascular anastomotic site. CONCLUSIONS: A penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery is an effective surgical method for correcting an arteriogenic erectile dysfunction with a normal corporeal veno-occlusive mechanism.
Arteries* ; Epigastric Arteries* ; Erectile Dysfunction ; Hematoma ; Humans ; Male ; Surveys and Questionnaires ; Ultrasonography, Doppler, Duplex

PURPOSE: We report the results of a penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery in arteriogenic impotent patients. MATERIALS AND METHODS: Microvascular arterial bypass surgery was performed in 5 impotent patients (age 29-40, mean 35 years) in order to treat a cavernosal arterial insufficiency secondary to focal occlusive disease in cavernosal arteries. The surgical procedure was performed on an end-to-side anastomosis of the inferior epigastric artery to the dorsal penile artery. The erectile function was evaluated by the International Index of the Erectile Function questionnaire (IIEF) and penile duplex Doppler ultrasonography before and 6 weeks after surgery. RESULTS: The IIEF score improved in 4 of 5 patients postoperatively. Penile arterial peak systolic velocity (PSV) had improved significantly from 21.4+/-2.2cm/sec to 33.7+/-9.6cm/sec in the right side, from 18.5+/-6.8cm/sec to 36.0+/-10.0cm/sec in the left (p< 0.05), respectively. There were no serious adverse effects of the surgery except for one patient who had a hematoma at the vascular anastomotic site. CONCLUSIONS: A penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery is an effective surgical method for correcting an arteriogenic erectile dysfunction with a normal corporeal veno-occlusive mechanism.
Arteries* ; Epigastric Arteries* ; Erectile Dysfunction ; Hematoma ; Humans ; Male ; Surveys and Questionnaires ; Ultrasonography, Doppler, Duplex

We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.
Aged, 80 and over ; Arteries ; Cadaver ; Epigastric Arteries ; Female ; Humans ; Iliac Artery ; Iliac Vein ; Ligaments

The obturator artery normally originates from the internal iliac artery. However, variation in the origin of obturator artery has been reported in many countries. Since no such case has been reported in Korea, we examined variations in the origin of obturator artery in cadavers donated to the medical school at the Chungbuk National University. Thirty-six pelvic halves from 18 cadaveric subjects (13 males and 5 females) were studied in this study. Normal origin of the obturator artery from the internal iliac artery was observed in 88.9% (16/18) of cadavers or in 91.7% (33/36) of pelvic halves. A variation in the origin of obturator artery was observed in 11.1% (2/18) of cadavers or in 8.3% (3/36) of pelvic halves. All of the variant obturator arteries originated from external iliac arteries as branches of inferior epigastric arteries. Bilateral presence of variant obturator arteries was observed in 5.6%(1/18) of cadavers. The obturator artery arose from inferior epigastric artery at a distance of 1 to 2.4 cm from origin point of inferior epigastric artery, and then the obturator artery ran inferiorly and medially with the inferior epigastric artery running superiorly and laterally. Presence of variant obturator artery would be important to clinical fields with interest to pelvic anatomy, such as radiology and surgery.
Arteries ; Cadaver ; Epigastric Arteries ; Humans ; Iliac Artery ; Korea ; Male ; Running ; Schools, Medical