title: Lumbar Artery Perforator Flap: An Anatomical Study Using Multidetector Computed Tomographic Scan and Surgical Pearls for Breast Reconstruction.
abstract: BACKGROUND
  Breast reconstruction with the lumbar artery perforator flap is indicated in patients with unfavorable abdominal donor site. In addition to their clinical experience with lumbar artery perforator free flap breast reconstruction, the authors present an anatomical study of the origin and course of the perforators.
  
  
  METHODS
  Images of multidetector computerized tomography scans were used to visualize the location of the dominant lumbar artery perforator in 20 patients. The medical files of the authors' patients who underwent lumbar artery perforator flap breast reconstruction were also analyzed.
  
  
  RESULTS
  Multidetector computed tomographic imaging in 20 female patients with a mean age of 47 years revealed an equal number of dominant perforators (10 left and 10 right); 60 percent were third lumbar artery perforators, 30 percent were fourth, and the remaining were second. The dominant perforators were mainly located 42.6 mm from the y axis at their origin at the transverse process, and 69.5 mm when emerging in the subcutaneous tissue. Six patients had nine successful lumbar artery perforator flaps for breast reconstruction. Average operative time was 270 minutes. Due to shortness of pedicle and mismatching between diameter of lumbar artery and internal mammary artery, vascular bypass (harvested from the deep inferior epigastric vessels) was required in 50 percent of the cases. The major complication at the donor site was seroma (80 percent).
  
  
  CONCLUSIONS
  The lumbar artery perforator has a constant anatomical location. The free lumbar artery perforator flap provides an ample amount of tissue for breast reconstruction; however, its major disadvantages are the small artery diameter, shortness of the pedicle, and high seroma rate at the donor site.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Hamdi
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Barbara
authors.initials: B
authors.lastname: Craggs
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Carola
authors.initials: C
authors.lastname: Brussaard
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Katrin
authors.initials: K
authors.lastname: Seidenstueker
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Benoit
authors.initials: B
authors.lastname: Hendrickx
authors.affiliation: Brussels, Belgium.|From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
authors.forename: Assaf
authors.initials: A
authors.lastname: Zeltzer
mesh_terms: D001940:Breast / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008161:Lumbosacral Region / Q000098:blood supply / Q000000981:diagnostic imaging; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply*; D012189:Retrospective Studies