The transverse lumbar perforator flap

An anatomic and clinical study

Bhagwat S. Mathur, Shaun S. Tan, F. A. Bhat, Warren Matthew Rozen

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)

Abstract

Background and aims Lumbosacral defects are complex reconstructive problems requiring tension-free vascularised soft tissue reconstruction in patients who often have comorbidities. 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, it has only been described in a small clinical and cadaveric study previously. Methods An anatomical study was performed in the 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 lumbar perforator flap was assessed in the reconstruction of lumbosacral defects. Results A total of 102 patients with 102 lumbosacral defects have been managed with the use of contralaterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients, the defects requiring reconstruction followed debridement of a pressure ulcer, with seven cases following debridement of pilonidal sinuses and one following abdominoperineal resection. There were 65 men and 37 women, 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 two cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All the donor sites were closed directly. Conclusion The contralateral-based transverse lumbar perforator flap is a simple, reliable, versatile and, in some cases, reusable choice in the management of lumbosacral defects. Flap dimensions of 24 × 15 cm can be based on one lumbar perforator.

Original languageEnglish
Pages (from-to)770-776
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume69
Issue number6
DOIs
Publication statusPublished - 1 Jun 2016

Keywords

  • Cadaveric study
  • Computed tomographic angiography
  • Lumbosacral defect
  • Perforator flap
  • Sacral sore

Cite this

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title = "The transverse lumbar perforator flap: An anatomic and clinical study",
abstract = "Background and aims Lumbosacral defects are complex reconstructive problems requiring tension-free vascularised soft tissue reconstruction in patients who often have comorbidities. 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, it has only been described in a small clinical and cadaveric study previously. Methods An anatomical study was performed in the 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 lumbar perforator flap was assessed in the reconstruction of lumbosacral defects. Results A total of 102 patients with 102 lumbosacral defects have been managed with the use of contralaterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients, the defects requiring reconstruction followed debridement of a pressure ulcer, with seven cases following debridement of pilonidal sinuses and one following abdominoperineal resection. There were 65 men and 37 women, 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 two cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All the donor sites were closed directly. Conclusion The contralateral-based transverse lumbar perforator flap is a simple, reliable, versatile and, in some cases, reusable choice in the management of lumbosacral defects. Flap dimensions of 24 × 15 cm can be based on one lumbar perforator.",
keywords = "Cadaveric study, Computed tomographic angiography, Lumbosacral defect, Perforator flap, Sacral sore",
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The transverse lumbar perforator flap : An anatomic and clinical study. / Mathur, Bhagwat S.; Tan, Shaun S.; Bhat, F. A.; Rozen, Warren Matthew.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 69, No. 6, 01.06.2016, p. 770-776.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - The transverse lumbar perforator flap

T2 - An anatomic and clinical study

AU - Mathur, Bhagwat S.

AU - Tan, Shaun S.

AU - Bhat, F. A.

AU - Rozen, Warren Matthew

PY - 2016/6/1

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N2 - Background and aims Lumbosacral defects are complex reconstructive problems requiring tension-free vascularised soft tissue reconstruction in patients who often have comorbidities. 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, it has only been described in a small clinical and cadaveric study previously. Methods An anatomical study was performed in the 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 lumbar perforator flap was assessed in the reconstruction of lumbosacral defects. Results A total of 102 patients with 102 lumbosacral defects have been managed with the use of contralaterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients, the defects requiring reconstruction followed debridement of a pressure ulcer, with seven cases following debridement of pilonidal sinuses and one following abdominoperineal resection. There were 65 men and 37 women, 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 two cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All the donor sites were closed directly. Conclusion The contralateral-based transverse lumbar perforator flap is a simple, reliable, versatile and, in some cases, reusable choice in the management of lumbosacral defects. Flap dimensions of 24 × 15 cm can be based on one lumbar perforator.

AB - Background and aims Lumbosacral defects are complex reconstructive problems requiring tension-free vascularised soft tissue reconstruction in patients who often have comorbidities. 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, it has only been described in a small clinical and cadaveric study previously. Methods An anatomical study was performed in the 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 lumbar perforator flap was assessed in the reconstruction of lumbosacral defects. Results A total of 102 patients with 102 lumbosacral defects have been managed with the use of contralaterally based transverse lumbar perforator flaps over a period of 20 years. In 96 patients, the defects requiring reconstruction followed debridement of a pressure ulcer, with seven cases following debridement of pilonidal sinuses and one following abdominoperineal resection. There were 65 men and 37 women, 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 two cases (both sacral pressure sores). All recurrences and/or necrosis were managed with flap advancement or skin grafts. All the donor sites were closed directly. Conclusion The contralateral-based transverse lumbar perforator flap is a simple, reliable, versatile and, in some cases, reusable choice in the management of lumbosacral defects. Flap dimensions of 24 × 15 cm can be based on one lumbar perforator.

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KW - Computed tomographic angiography

KW - Lumbosacral defect

KW - Perforator flap

KW - Sacral sore

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