# “The Three Gorges” flap based on three tributaries—the bilateral deep inferior epigastric, superficial circumflex and external pudendal systems

## TL;DR

This study introduces a new surgical flap design using three blood vessel systems from the abdominal region, supported by real-time imaging and anatomical dissection.

## Contribution

The novel 'Three Gorges' flap combines three arterial systems and is perfused solely via the DIEP pedicles, as demonstrated using fluorescence angiography.

## Key findings

- The Three Gorges flap is perfused via the bilateral DIEP pedicles.
- Anatomical dissection and fluorescence angiography confirmed the perfusion of the SCIP and external pudendal systems.
- A new mega-flap design based on three arterial systems is feasible for surgical applications.

## Abstract

This study aims to identify a novel mega-flap from the abdominal region. The flap is an extension of the bipedicled DIEP to incorporate the bilateral superficial circumflex iliac perforator (SCIP) and external pudendal arterial systems. These arise from the common femoral artery, hence termed “The Three Gorges” flap. We utilized a novel indocyanine green fluorescence angiography method to evaluate the perfusion of this flap solely via the bilateral DIEP pedicles. Anatomical dissection of three cadavers was performed to map the perfusion zone of the flap via bilateral DIEP pedicles. Indocyanine green fluorescence angiography was employed to capture the perfusion in real time. The SCIP and superficial external pudendal systems can be perfused by the DIEP pedicle. A novel mega-flap based on three tributaries from bilateral DIEP, SCIP, and superficial external pudendal arterial systems can be supplied by bilateral DIEP pedicles.