title: The lumbar artery perforators: a cadaveric and clinical anatomical study.
abstract: BACKGROUND
  The lumbar region has been scarcely explored as a donor site for free tissue transfer or as a free flap recipient site. The lumbar integument provides a versatile prospective flap site, with a potentially well-concealed scar. Similarly, defects of this region can require recipient vessels that may be difficult to identify. Although lumbar artery perforators have been described, the reliability of perforators in this region remains questionable.
  
  
  METHODS
  An anatomical study was undertaken combining both cadaveric and in vivo analysis of the lumbar vessels. The cadaveric component comprised both dissection and angiographic studies in fresh and embalmed cadavers (36 lumbar regions in 18 cadavers), and the clinical study comprised a computed tomographic angiographic study (44 sides in 22 patients) and an operative case report.
  
  
  RESULTS
  Perforators were shown to arise from all eight lumbar arteries to enter the lumbar integument, with their size, location, and course described. Lower lumbar perforators were more often septocutaneous and of larger caliber. A case in which the fourth lumbar artery and concomitant vein were used as free flap recipient vessels is described, the first such reported case in the literature.
  
  
  CONCLUSIONS
  Improving the incidence of identifying lumbar perforators of large caliber and with a septocutaneous course can be achieved by selecting lower lumbar vessels, or with the use of preoperative computed tomographic angiography. Computed tomographic angiography can successfully identify the location, size, and course of lumbar artery perforators and can aid flap design. Lumbar artery perforators are highly useful for both donor and recipient vessels in free flap surgery.
authors.affiliation: Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne.
authors.forename: Birgitte J
authors.initials: BJ
authors.lastname: Kiil
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Wei Ren
authors.initials: WR
authors.lastname: Pan
authors.forename: Damien
authors.initials: D
authors.lastname: Grinsell
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ashton
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Corlett
authors.forename: G Ian
authors.initials: GI
authors.lastname: Taylor