Kiil Birgitte J, Rozen Warren M, Pan Wei Ren, Grinsell Damien, Ashton Mark W, Corlett Russell J, Taylor G Ian
Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne.
Plast Reconstr Surg. 2009 Apr;123(4):1229-1238. doi: 10.1097/PRS.0b013e31819f299e.
The lumbar region has been scarcely explored as a donor site for free tissue transfer or as a free flap recipient site. The lumbar integument provides a versatile prospective flap site, with a potentially well-concealed scar. Similarly, defects of this region can require recipient vessels that may be difficult to identify. Although lumbar artery perforators have been described, the reliability of perforators in this region remains questionable.
An anatomical study was undertaken combining both cadaveric and in vivo analysis of the lumbar vessels. The cadaveric component comprised both dissection and angiographic studies in fresh and embalmed cadavers (36 lumbar regions in 18 cadavers), and the clinical study comprised a computed tomographic angiographic study (44 sides in 22 patients) and an operative case report.
Perforators were shown to arise from all eight lumbar arteries to enter the lumbar integument, with their size, location, and course described. Lower lumbar perforators were more often septocutaneous and of larger caliber. A case in which the fourth lumbar artery and concomitant vein were used as free flap recipient vessels is described, the first such reported case in the literature.
Improving the incidence of identifying lumbar perforators of large caliber and with a septocutaneous course can be achieved by selecting lower lumbar vessels, or with the use of preoperative computed tomographic angiography. Computed tomographic angiography can successfully identify the location, size, and course of lumbar artery perforators and can aid flap design. Lumbar artery perforators are highly useful for both donor and recipient vessels in free flap surgery.
作为游离组织移植的供区或游离皮瓣受区，腰椎区域很少被研究。腰部皮肤提供了一个多功能的潜在皮瓣供区，瘢痕可能易于隐藏。同样，该区域的缺损可能需要难以识别的受区血管。虽然已经描述了腰动脉穿支，但该区域穿支的可靠性仍存在疑问。
进行了一项解剖学研究，结合尸体和活体对腰部血管的分析。尸体部分包括在新鲜和防腐尸体上进行的解剖和血管造影研究（18具尸体的36个腰部区域），临床研究包括计算机断层血管造影研究（22例患者的44侧）和1例手术病例报告。
显示所有8条腰动脉均发出穿支进入腰部皮肤，并描述了其大小、位置和走行。下腰部穿支更常为肌皮穿支且口径较大。描述了1例使用第四腰动脉及其伴行静脉作为游离皮瓣受区血管的病例，这是文献中首次报道的此类病例。
选择下腰部血管或使用术前计算机断层血管造影可提高识别大口径且走行为肌皮穿支的腰穿支的概率。计算机断层血管造影可成功识别腰动脉穿支的位置、大小和走行，并有助于皮瓣设计。腰动脉穿支在游离皮瓣手术中作为供区和受区血管都非常有用。
