title: Early experience with the free lumbar artery perforator flap for breast reconstruction.
abstract: BACKGROUND
  Autologous breast reconstruction has become a progressively more popular method of breast reconstruction. A wide variety of perforator flaps have been described and subsequently refined to decrease donor-site morbidity. Recently, the lumbar artery perforator (LAP) flap has been reported as an option for autologous breast reconstruction.
  
  
  METHODS
  This study summarises the prospectively gathered data of 35 free LAP flaps for breast reconstruction in 28 patients. The mean follow-up was 18 months.
  
  
  RESULTS
  The internal mammary artery and the venae comitantes were used as recipient vessels in all reconstructions. In 80% of the reconstructions (28 flaps), an interposition graft was used. Six flaps (17%) had to be revised for venous thrombosis. Two of the revised flaps (5.7%) could not be salvaged, and total flap necrosis occurred. The mean operating time was 6 h and 15 min, 6 h and 39 min when an interposition graft was used and 5 h and 23 min when no interposition graft was necessary.
  
  
  CONCLUSIONS
  The LAP flap should be considered as a further alternative for breast reconstruction in patients in whom a deep inferior epigastric artery perforator (DIEAP) flap is not possible or not desirable. Shaping of this flap is easier compared to any other flaps due to the quality of the lumbar fat and the gluteal extension. An interposition graft is frequently used to facilitate anastomosis, either to lengthen the pedicle or to resolve size mismatch. This is a disadvantage of the LAP flap.
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Gent, Belgium.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Peters
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Gent, Belgium. Electronic address: phillip.blondeel@ugent.be.
authors.forename: Phillip N
authors.initials: PN
authors.lastname: Blondeel
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Gent, Belgium.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lobo
authors.affiliation: Department of Plastic Surgery, Gent University Hospital, Gent, Belgium.
authors.forename: Koenraad
authors.initials: K
authors.lastname: van Landuyt
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery; D008875:Middle Aged; D061646:Operative Time; D061525:Perforator Flap / Q000098:blood supply*; D011446:Prospective Studies; D012086:Reoperation; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery
keywords: Autologous; Breast reconstruction; Lumbar artery; Perforator flap