title: Management of giant inferior triangle lumbar hernia (Petit's triangle hernia): A rare complication following delayed breast reconstruction with extended latissimus dorsi myocutaneous flap.
abstract: BACKGROUND
  Lumbar triangle hernia after breast reconstruction with latissimus dorsi flap (LDMF) is a very rare complication and few cases were previously described. Muscle mobilization and iatrogenic fascia defect are related etiologic factors.
  
  
  METHODS
  The authors describe a rare case of lumbar hernia in a 58-year-old woman who underwent delayed left breast reconstruction with LDMF. Two months after surgery, a progressive symptomatic lower left lumbar bulge was observed. The CT scan confirmed the diagnosis and delineated an 18cm lumbar defect filled with lower and large bowel. At operation, the defect was exposed and the hernia sac reduced. In order to obtain stability, the remained local muscle and fascia flaps were mobilized into the defect. Additional strength was achieved with a two-layer closure of prosthetic mesh (intra/extra peritoneal). The patient is currently in the 10th postoperative year of hernia repair and satisfactory lumbar wall contour was achieved. Neither the recurrence of lumbar hernia nor symptoms compliance was noted.
  
  
  CONCLUSIONS
  Lumbar hernia is an uncommon complication of LDMF harvest. Although it is a rare disease, general and plastic surgeons must be on alert to avoid complications and misdiagnosis. Seroma differential diagnosis is important in order to avoid bowel perforation due to aspiration. Defect reconstruction is necessary with a muscular and fascia flaps mobilization and synthetic mesh in order to obtain a stable repair.
  
  
  CONCLUSIONS
  The knowledge of this rare post-operative complication following delayed breast reconstruction is crucial to its surgical management. Early surgical intervention is warranted in order to avoid severe complications.
authors.affiliation: Hospital Sírio Libanês, São Paulo, Brazil. Electronic address: munhozalex@uol.com.br.
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.affiliation: Cancer Institute of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montag
authors.affiliation: Cancer Institute of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo Gustavo
authors.initials: EG
authors.lastname: Arruda
authors.affiliation: Hospital das Clínicas University of São Paulo, Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Sturtz
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
keywords: Breast reconstruction; Complication; Hernia; Lumbar triangle; Myocutaneous flap