Lumbar Artery Perforator Flap for Breast Reconstruction

Hamdi, Moustapha; Antoniazzi, Elisa

doi:10.1007/978-3-030-34603-4_22

Cited by 7 publications

(14 citation statements)

References 16 publications

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“…From our review, 4 studies used in vivo computed tomography angiogram, which may best represent the number of perforators for free tissue transfer in the context of surgical planning. These studies reported 5 ± 2 8 and 3.2 ± 1.68 6 perforators per patient. Our review also suggests that L4 generally yields more perforators 3,7,19 .…”

Section: Discussionmentioning

confidence: 91%

“…Most studies discovered an average of 5 to 6 LAPs, and in general, there is an increase in number, caliber, and septocutaneous course of perforators from L1 to L4 levels. Whereas some suggest the L1 and L4 lumbar arteries give rise to more perforators, 3 another study by Hamdi et al 8 found the L3 and L4 lumbar arteries to be most fruitful. The mean diameter of these perforators ranged from 0.7 to 2.3 mm, and L4 perforators were consistently the largest.…”

Section: Resultsmentioning

confidence: 99%

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Lumbar Artery Perforator Flaps

et al. 2022

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Background: The lumbar artery perforator (LAP) flap has gained popularity as a versatile flap in reconstructive surgery; however, few studies have analyzed salient characteristics of this flap. We set out to provide a comprehensive appraisal of free tissue transfers of LAP flaps with specific attention to anatomic features and clinical outcomes. Methods: Using preferred reporting items for systematic reviews and meta-analyses guidelines, we identified clinical, radiographic, and cadaveric studies of LAP flaps and assessed outcomes, complications, and anatomic parameters, such as pedicle length, diameter, location, and course. Results: A total of 254 articles were initially reviewed, of which 18 met the final inclusion criteria. Ten studies were primarily concerned with anatomic characteristics, and most clinical studies related to breast reconstruction. The operative durations varied between 4.8 and 9.2 hours. Partial and total flap losses were estimated at 2.6% and 7.6%, respectively. Acute revision rates ranged from 16% to 24% related to hematoma, arterial thrombus, and venous thrombus. Donor-site seromas were frequently encountered in breast reconstruction with an incidence of 17% to 78%. Conclusions:The LAP flap has demonstrated favorable outcomes in various reconstructive scenarios. The caudal perforators generally offer more pedicle length, greater pedicle diameter, and septocutaneous course and may be better suited for flap design. For breast reconstruction, the LAP flap is a useful alternative to abdominalbased flaps, and special attention should be given to optimizing pedicle length using interposition grafts and methods that minimize seroma formation at the donor site.

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Section: Discussionmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Lumbar Artery Perforator Flaps

et al. 2022

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“…The skin of the ICAP flap from the lateral and anterior thoracic region has the same texture as breast skin leading to a favorable result. Secondly, the LICAP flap is based on the anterior perforator to the LD muscle, so it does not compromise the thoracodorsal vessels [46]. Compared to the latissimus flap, the present technique has further advantages as it is less time-consuming, does not require any unique positioning for the procedure, and there is no loss of muscle function.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Dube¹,

Sharma²,

Puthu³

2023

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Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1 st January 2018 to 30 th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m 2 . The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively.

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“…This includes several donor sites such as the lumbar artery perforator flap, transverse myocutaneous gracilis flap and the superior gluteal artery perforator flap. [16][17][18] At the same time, when a secondary or tertiary flap is required, it remains imperative to carefully assess the patient for coagulation disorders. 19 Again, alternate donor sites (thighs for TUG/PAP flaps, lumbar area for LAP flaps, gluteal area for SGAP/IGAP, and back for LD flap) should be considered, and the patient should be informed preoperatively about this.…”

Section: Discussionmentioning

confidence: 99%

An Algorithm in Managing Deep Inferior Epigastric Vessel Interruption in Free Flap Breast Reconstruction

Kapila

Kempný

Knoz

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Previous surgical procedures in the abdomen are no longer contra-indications for free flap breast reconstruction using the deep inferior epigastric artery perforator flap. Nonetheless, a possible consequence of previous surgical procedures may be trauma to the deep inferior epigastric (DIE) pedicle, leading to interruption. In these cases, a modification in operative strategy may be required. Methods: A study was performed across two centers, during a 10-year period between January 1, 2010 and December 2019. Patient and outcome data were collected from the patient file and operation notes. Results: Four cases with clear evidence of DIE pedicle interruption were found, with an average age of 54 years and an average body mass index of 28.9. Three patients had a preoperative diagnosis of DIE pedicle interruption on CT angiography, whereas in one case this was found peroperatively. For three cases, unilateral reconstruction was performed, and for one, bilateral reconstruction. Four flaps (in three cases) were unipedicled; the contralateral DIE pedicle was used in three, and the superficial system was used in one. For the bipedicled case, two hemiflaps were used, with the interrupted DIE pedicle anastomosed to a branch of the contralateral DIE pedicle. Conclusions: Interrupted DIE vessels remain a challenge for free flap breast reconstruction. The four cases demonstrated in this article highlight different surgical strategies, with an emphasis on detailed preoperative planning, including CT angiography. We present an algorithm to aid the reader in approaching cases with an interrupted DIE pedicle.

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Lumbar Artery Perforator Flap for Breast Reconstruction

Cited by 7 publications

References 16 publications

Lumbar Artery Perforator Flaps

Lumbar Artery Perforator Flaps

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

An Algorithm in Managing Deep Inferior Epigastric Vessel Interruption in Free Flap Breast Reconstruction

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