Preliminary experience in breast reconstruction with the free vertical deep inferior epigastric perforator flap.

The transverse abdominoplasty flap based on the perforators of the deep inferior epigastric pedicle (DIEP) is not indicated in patients with longitudinal midline abdominal scars because of the poor midline crossover of blood and the high risk of necrosis of the distal flap. Four patients who required breast reconstruction and presented with a mid-abdominal scar and an incongrous half abdomen, had a flap outlined vertically over the rectus abdominis muscle (VDIEP). The flaps were transferred to the thorax and reperfused to the thoracodorsal vessels. All flaps healed uneventfully which showed that the VDIEP is a reliable option for breast reconstruction, with the abdominoplasty flap, in patients with a vertical mid-abdominal scar. This flap seems to be perfused more robustly than the transverse DIEP; it has a better arterial inflow because of the inclusion of zone I and II alone according to Scheflan's model, and an easier longitudinal venous outflow.