Bissell Mary Beth, Greenspun David T, Levine Josh, Rahal William, Al-Dhamin Ammar, AlKhawaji Ali, Morris Steven F
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.
Ann Plast Surg. 2016 Oct;77(4):469-76. doi: 10.1097/SAP.0000000000000646.
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.
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.
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).
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.
腰椎区域是基于穿支的旋转皮瓣或游离皮瓣的潜在供区，也可作为游离皮瓣的受区，用于覆盖骶骨区域的缺损。由于关于这个潜在皮瓣供区的微血管解剖结构缺乏共识，因此需要对该区域的解剖结构进行深入研究。
使用MIMICS软件（Materialise，比利时）对四对腰血管中的每一对生成腰椎区域微血管的三维重建图（n = 6）。记录所有腰动脉（LA）穿支的直径、走行和蒂长度。使用SigmaStat 4.0进行统计分析，使用GraphPad Prism 6软件生成图表。
第一对腰动脉发出的穿支可在第12肋下缘可靠检测到，从中线向下并向外延伸，而第四对腰动脉发出的穿支则沿连接髂后上棘的水平面穿入筋膜。第一对（L1）和第四对（L4）腰动脉发出的皮穿支明显多于第二对（L2）和第三对（L3）（均值±标准差：L1，5.5±1.2；L2，1.4±0.7；L3，1.3±0.7；L4，4.8±1.0；P<0.05）。L1发出的穿支平均直径大于L4发出的穿支（直径±标准差：L1，1.2mm±0.2>L4，0.8mm±0.2；P<0.0001）。L1和L4穿支的蒂长度比L2和L3发出的穿支长（长度±标准差：L1，98.2mm±57.8；L4，106.1mm±23.3>L2，67.5mm±27.4；L3，78.5mm±30.3；P<0.05）。
第一和第四腰动脉发出的穿支以可预测的方式出现，有足够的蒂长度，且直径合适，可用于支持穿支皮瓣。我们展示了一个病例以支持该皮瓣在微血管乳房重建中的潜在应用。
