title: Lateral thigh perforator flap for breast reconstruction: Computed tomographic angiography analysis and clinical series.
abstract: OBJECTIVE
  Although abdominal-based flaps remain the first choice for autologous breast reconstruction, alternative donor sites are necessary when the abdomen is unavailable. Abdominal donor site suitability is determined, at times, according to deep inferior epigastric perforator (DIEP)-protocol computed tomographic angiography (CTA) results. CTA provides information about the pelvis/upper thigh that can be used to evaluate the suitability of other donor sites. This study aimed to examine the utility of DIEP-protocol CTA in the assessment of a lateral thigh perforator (LTP) flap. Furthermore, a small clinical LTP flap breast reconstruction series was presented.
  
  
  METHODS
  The LTP flap anatomy was studied in 100 DIEP-protocol CT angiographies (200 thighs). Collected data included lateral circumflex femoral artery (LCFA) origin; number, type, and course of LTPs; pedicle characteristics; and reference point measurements. Relative relationships between reference point anatomy and perforator anatomy were analyzed.
  
  
  RESULTS
  Perforators originated from the LCFA ascending branch (4.6 mm average diameter), averaging 2.6 perforators/thigh. The mean estimated pedicle length was 7.7 cm (±0.7 cm). Septocutaneous perforators were present in 97% (1.8 perforators/thigh). Musculocutaneous perforators were present in 64% (0.9 perforators/thigh). The mean distance between anterior superior iliac spine and perforator was 9.9 cm (±1.5 cm). Perforators were located 0.13 cm (±1.1 cm) below the pubic symphysis. Our LTP flap clinical series featured dissection in the supine position and primary donor site closure and highlighted the difficulty in flap design (six patients, nine LTP flaps).
  
  
  CONCLUSIONS
  LTPs are consistent, reliably present, and radiographically appear to be suitable for microsurgical transfer. DIEP-protocol CTA is an acceptable method for imaging the pertinent LTP anatomy.
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace St, 6B Scaife Hall, Pittsburgh, PA, 15261, United States.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Maricevich
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace St, 6B Scaife Hall, Pittsburgh, PA, 15261, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bykowski
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace St, 6B Scaife Hall, Pittsburgh, PA, 15261, United States.
authors.forename: M Asher
authors.initials: MA
authors.lastname: Schusterman
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace St, 6B Scaife Hall, Pittsburgh, PA, 15261, United States.
authors.forename: Evan B
authors.initials: EB
authors.lastname: Katzel
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace St, 6B Scaife Hall, Pittsburgh, PA, 15261, United States.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Gimbel
mesh_terms: D000368:Aged; D064591:Allografts / Q000098:blood supply / Q000000981:diagnostic imaging; D059925:Anatomic Landmarks; D000072226:Computed Tomography Angiography; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D013848:Thigh; D060053:Transplant Donor Site / Q000098:blood supply
keywords: Breast reconstruction; Lateral thigh; Microsurgery; Perforator; Preoperative imaging; Saddlebags