The transverse lumbar perforator flap: An anatomic and clinical study.
OBJECTIVE
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.


CONCLUSIONS
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.
St Andrew's Centre for Plastic Surgery and Burns, Room E322, Stock Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK; Department of Plastic Surgery, PO Box 2897, Riyadh Medical Complex, Riyadh, 11196, Saudi Arabia.
Bhagwat S
BS
Mathur
Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton 3168, Victoria, Australia.
Shaun S
SS
Tan
Department of Plastic Surgery, PO Box 2897, Riyadh Medical Complex, Riyadh, 11196, Saudi Arabia.
F A
FA
Bhat
St Andrew's Centre for Plastic Surgery and Burns, Room E322, Stock Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK; Department of Surgery, School of Clinical Science at Monash Health, Faculty of Medicine, Monash University, Monash Medical Centre, Clayton 3168, Victoria, Australia. Electronic address: warrenrozen@hotmail.com.
Warren Matthew
WM
Rozen
D000328:Adult; D000368:Aged; D000718:Anatomy, Regional / Q000379:methods; D001158:Arteries / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography / Q000379:methods; D003646:Debridement / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008161:Lumbosacral Region / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D003668:Pressure Ulcer / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
Cadaveric study; Computed tomographic angiography; Lumbosacral defect; Perforator flap; Sacral sore