The lumbar artery perforator flap: clinical review and guidance on image reporting

Mujtaba, Bilal; Hanafy, Abdelrahman K.; Largo, René D.; Taher, Ahmed; Madewell, John E.; Costelloe, Colleen M.; Layman, Rick R.; Morani, Ajaykumar C.

doi:10.1016/j.crad.2019.05.032

Cited by 11 publications

(14 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When considering autologous free flap breast reconstruction, the DIEP flap is generally considered first line because of its generous pedicle length, uncomplicated harvest, minimal donor-site morbidity, and tissue compliance. In patients with contraindications or who lack sufficient abdominal tissue, other perforator flaps, such as those based on the gluteal, medial circumflex, and profunda arterial systems, have demonstrated success 22 . These options are not without limitations, however.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lumbar Artery Perforator Flaps

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The gluteal artery perforator, for example, contains adipose tissue, which may lack optimum flexibility to allow proper breast shaping. 22 Significant depression and flattening of the buttock may also result postoperatively after harvest. The tissues in the medial and posterior thigh generally lack significant adiposity in most patients.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Artery Perforator Flaps

et al. 2022

View full text Add to dashboard Cite

show abstract

“…reconstruction have been aided by several technological advancements. Sophisticated imaging modalities have allowed for precise planning of autologous donor site vascular anatomy with the goal of defining the perforator(s) diameter, course, and length of the pedicle (12). The two most common types of imaging are CTA and MRA.…”

Section: Computed Topographic Angiography (Cta) or Magnetic Resonance Angiography (Mra)mentioning

confidence: 99%

“…There is consistent pedicle location and ease of elevation. The donor site is appealing for most women as it is easily hidden in clothing, offers large volume with reported softer fat that is more breast-like (12,56) with the potential for anastomosis of sensory nerves (54).…”

Section: Lumbar Artery Perforator (Lap) Flapmentioning

confidence: 99%

“…Importantly, these authors advocate routine harvesting of the deep inferior epigastric vascular bundle as interposition graft to avoid a lengthy, pedicle dissection and provide a better caliber match between the mammary vessels and the flap pedicle. The requirement of an interposition graft is the main disadvantage of the LAP flap (12,54,56). Nonetheless it is a useful tool in the microsurgical breast reconstruction armamentarium.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Alternative flaps in autologous breast reconstruction

Myers¹,

Nelson²,

Allen³

2021

Gland Surg

View full text Add to dashboard Cite

The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction.Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.

show abstract

From Angiosomal to Bi‐Angiosomal and Extra‐Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction

Brunetti,

Morelli Coppola,

Petrucci

et al. 2024

Microsurgery

View full text Add to dashboard Cite

IntroductionThe use of free‐style and propeller perforator‐based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator‐based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from angiosomal to bi‐angiosomal and extra‐angiosomal perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios.Patients and MethodsA total of 15 patients underwent abdominal wall reconstruction with angiosomal, bi‐angiosomal, and extra‐angiosomal pedicled perforator‐based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft‐tissue sarcomas (STS) and non‐melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post‐operative course, and complications were recorded. Moreover, at 12 months follow‐up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5‐point Likert scale.ResultsTen angiosomal perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 bi‐angiosomal and extra‐angiosomal conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP‐SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm2 (mean size was 194.7 cm2). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm2 (mean surface was 209.3 cm2). No major complications were registered. One bi‐angiosomal bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12‐month follow‐up except one, who did not show for clinical follow‐up but responded at the Likert scale at clinical follow‐up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87.ConclusionThe use of local tissues is an under‐utilized solution in the field of abdominal wall reconstruction. Angiosomal, bi‐angiosomal, and extra‐angiosomal perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival.

show abstract

The lumbar artery perforator flap: clinical review and guidance on image reporting

Cited by 11 publications

References 35 publications

Lumbar Artery Perforator Flaps

Lumbar Artery Perforator Flaps

Alternative flaps in autologous breast reconstruction

From Angiosomal to Bi‐Angiosomal and Extra‐Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction

Contact Info

Product

Resources

About