Transverse and oblique deep inferior epigastric artery perforator (DIEP) flaps are widely used in breast, lower extremity, urogenital, head and neck reconstruction. In this report, we present our experience with selecting perforator vessels for transverse and oblique DIEP flaps based on an anatomical study and clinical cases.

A detailed anatomical study of the DIEP flap was carried out using a standardized injection of lead oxide in 10 fresh cadavers. Additionally, 35 male pediatric patients (age 5–12 years) underwent lower extremity reconstruction with a DIEP flap. A transverse DIEP flap was used when the defect template did not exceed zone IV, while an oblique DIEP flap was used when the defect template exceeded zone IV.

Perforators located below the umbilicus in zones I and II were rich in transverse anastomoses across the midline of the abdominal wall, which is the basis for the transverse DIEP flap. Perforators lateral to the umbilicus in zone I had true anastomoses with the musculophrenic artery, the morphological basis for the oblique DIEP flap. The DIEP flap design was transverse in 20 patients and oblique in 15. Flap sizes ranged from 8 × 4.5 cm² to 24 × 9 cm². One oblique DIEP flap was necrosed totally, and it was repaired by a latissimus dorsi musculocutaneous flap.

The transverse DIEP flap design based on the perforator located below the umbilicus in zone I is recommended for small skin and soft tissue defects. We recommend the use of the oblique DIEP flap design based on the perforator lateral to the umbilicus in zone I as an extended flap to reconstruct large tissue defects.

横向和斜向腹壁下动脉穿支（DIEP）皮瓣广泛用于乳房、下肢、泌尿生殖、头颈部重建。在本报告中，我们根据解剖学研究和临床病例介绍了我们为横向和斜向 DIEP 皮瓣选择穿支血管的经验。

在 10 具新鲜尸体中使用标准化的氧化铅注射液对 DIEP 皮瓣进行了详细的解剖学研究。此外，35 名男性儿科患者（年龄 5-12 岁）接受了 DIEP 皮瓣的下肢重建。当缺损模板不超过 IV 区时使用横向 DIEP 皮瓣，而当缺损模板超过 IV 区时使用倾斜 DIEP 皮瓣。

位于 I 区和 II 区脐下方的穿支在腹壁中线处有丰富的横向吻合，这是横向 DIEP 皮瓣的基础。I区脐外侧的穿支与肌膈动脉有真正的吻合，这是斜DIEP皮瓣的形态学基础。DIEP 皮瓣设计在 20 名患者中是横向的，在 15 名患者中是倾斜的。皮瓣尺寸范围从 8 × 4.5 cm ²到 24 × 9 cm ²。1个斜DIEP皮瓣完全坏死，用背阔肌肌皮瓣修复。

对于小的皮肤和软组织缺损，建议使用基于位于 I 区脐下方的穿支的横向 DIEP 皮瓣设计。我们建议使用基于 I 区脐外侧穿支的倾斜 DIEP 皮瓣设计作为扩展皮瓣来重建大的组织缺损。