Circummuscular variant of the deep inferior epigastric perforator in breast reconstruction: importance of preoperative multidetector computed tomographic angiography.

The deep inferior epigastric artery perforator is reliable and widely used in breast reconstruction. The anatomy and course of deep inferior epigastric vessels and their branches are relatively constant and well understood. However, some published cases with a direct perforating pattern and no intramuscular traveling were identified. A case involving a circummuscular variant of a deep inferior epigastric artery perforator is described as well as its clinical importance. This apprises clinicians who perform a transverse rectus abdominis muscle free flap procedure that there can be a rare circummuscular pedicle variant and that it is vulnerable to injury.