The Transverse Lumbar Perforator Flap: An Anatomic and Clinical Study

Publication date: Available online 7 April 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Bhagwat S. Mathur, Shaun S. Tan, F.A. Bhat, Warren Matthew Rozen
BackgroundLumbosacral defects are complex reconstructive problems requiring tension free vascularised soft tissue reconstruction in patients who often have co-morbidities. In an area prone to recurrent tissue breakdown, both free and islanded flaps risk complete failure. Cadaveric studies have demonstrated the consistency of lumbar perforators, yet ipsilateral lumbar perforator flaps have modest reconstructive potential owing to geometric limitations. An axial pattern lumbar perforator flap based on a contralateral lumbar perforator may surmount these problems, however has only been described in a small clinical and cadaveric study previously.MethodsAn anatomical study was performed in consecutive patients undergoing computed tomographic angiography (CTA) of the trunk, assessing the presence and location of lumbar artery perforators. The use of midline or contralateral lumbar artery perforators in the use of a lumbar perforator flap was assessed in the reconstruction of lumbosacral defects.Results102 patients with 102 lumbosacral defects have been managed with the use of contra laterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients the defect requiring reconstruction followed debridement of a pressure ulcer, with 7 cases following debridement of pilonidal sinuses and 1 case following Abdomino-perineal resection. There were 65 males and 37 females, with a mean follow up of 1.5 years. Necrosis of the tip of the flap occurred in 3%, with no cases of complete flap loss. Recurrence occurred in 2 cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All donor sites were closed directly.ConclusionThe contralaterally based transverse lumbar perforator flap is a simple, reliable, versatile and in some cases re-usable choice in the management of lumbosacral defects. Flap dimensions of 24 x 15 cm can be based on one lumbar perforator.



from #ENT via xlomafota13 on Inoreader http://ift.tt/1PVZOYL
via IFTTT