title: The Lumbar Artery Perforator Flap: 3-Dimensional Anatomical Study and Clinical Applications.
abstract: BACKGROUND
  The lumbar region is a potential donor site for perforator-based rotational or free flaps or as a recipient site for free flaps to obtain coverage for deficits in the sacral region. Because of the lack of consensus regarding the microvascular anatomy of this potential flap site, a robust investigation of the anatomy of this region is required.
  
  
  METHODS
  Three-dimensional reconstructions (n = 6) of the microvasculature of the lumbar region were generated using MIMICS software (Materialise, Belgium) for each of the four paired lumbar vessels. Diameter, course, and pedicle length were recorded for all lumbar artery (LA) perforators. Statistical analysis was performed using SigmaStat 4.0 and graphs were generated using GraphPad Prism 6 Software.
  
  
  RESULTS
  Perforators arising from the first pair of LAs are reliably detected along the inferior margin of the 12th rib, extending inferiorly and laterally from the midline while perforators arising from the fourth pair of LA perforate the fascia along a horizontal plane connecting the posterior iliac crests. There are significantly more cutaneous perforators arising from the first (L1) and fourth (L4) pairs of LA than from the second (L2) and third (L3) (mean ± SD: L1, 5.5 ± 1.2; L2, 1.4 ± 0.7; L3, 1.3 ± 0.7; L4, 4.8 ± 1.0; P < 0.05). The average perforator diameter arising from L1 is greater than those arising from L4 (diameter ± SD: L1, 1.2 mm ± 0.2 >L4, 0.8 mm ± 0.2; P < 0.0001). L1 and L4 perforators have longer pedicle lengths than those arising from L2 and L3 (length ± SD: L1, 98.2 mm ± 57.8; L4, 106.1 mm ± 23.3 >L2, 67.5 mm ± 27.4; L3, 78.5 mm ± 30.3; P < 0.05).
  
  
  CONCLUSIONS
  Perforators arising from the first and fourth LAs arise in a predictable fashion, have adequate pedicle lengths, and are of suitable diameter to support a perforator flap. We present a case to support the potential use of this flap for microvascular breast reconstruction.
authors.affiliation: From the *Division of Diagnostic Radiology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada; †Plastic, Reconstructive and Microvascular Surgery, New York, NY; and ‡Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Bissell
authors.forename: David T
authors.initials: DT
authors.lastname: Greenspun
authors.forename: Josh
authors.initials: J
authors.lastname: Levine
authors.forename: William
authors.initials: W
authors.lastname: Rahal
authors.forename: Ammar
authors.initials: A
authors.lastname: Al-Dhamin
authors.forename: Ali
authors.initials: A
authors.lastname: AlKhawaji
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
mesh_terms: D000328:Adult; D001158:Arteries / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography / Q000379:methods; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008161:Lumbosacral Region / Q000098:blood supply* / Q000000981:diagnostic imaging; D016462:Mammaplasty / Q000379:methods*; D055806:Microvessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D061330:Multidetector Computed Tomography / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply*