Table 2. Nerves with suitable sensory branches per flap type.
| Flap | Sensory nerve options | Clinical pearls |
|---|---|---|
| Deep inferior epigastric artery perforator | 10th–12th icn | Merely the sensory branches should be transected, after the mixed nerve splits into a distinct sensory and motor branch. The sensory branches pierce the anterior rectus sheath along the medial and lateral perforators through and continue into the subcutaneous tissue |
| Stacked hemi-abdominal extended perforator | 10th–12th icn and sometimes cutaneous iliohypogastric nerve | See DIEP flap innervation. If a dual innervation is not possible, innervating the superficial part of the flap is recommended |
| Latissimus dorsi | lateral branch of dorsal division of 7th thoracic nerve (sometimes 6th or 8th) | Nerves enter the flap from an upper medial oblique direction and are usually located caudally in the flap |
| Lumbar artery perforator | Superior cluneal nerves or 12th lateral icn | Cluneal nerves perforate the thoracolumbar fascia and run along the perforators |
| Superior gluteal artery perforator | Dorsal branches of lumbar segmental nerves | Multiple large caliber nerves are usually present. They are located laterally at the superior edge of the flap, cranial to the perforators |
| Septocutaneous gluteal artery perforator | 12th icn, lateral branch | The nerves pass between the internal oblique and transversus abdominis muscles, and continue toward the lateral margin of the rectus sheath from posterosuperior to anteroinferior |
| Inferior gluteal artery perforator | Posterior femoral cutaneous nerve | The nerves accompany the perforator. They are encountered in the subfascial plane along the inferior incision in the gluteal crease, and proximally in the subfascial plane during dissection of the vascular pedicle |
| Diagonal/transverse upper gracilis | Anterior femoral cutaneous nerve or obturator nerve | Sensory nerves enter the flap medially, distinct from the vascular pedicle |
| Profunda artery perforator | Posterior femoral cutaneous nerve | Nerves usually pierce the adductor magnus muscle a few centimeters lateral to the perforator |
| Lateral thigh perforator | Lateral femoral cutaneous nerve | The nerve is located at the anterior border of the flap, cranially to the septocutaneous perforator, and easy to identify |
icn, intercostal nerve; DIEP, deep inferior epigastric perforator.