Hamdi Moustapha, Craggs Barbara, Brussaard Carola, Seidenstueker Katrin, Hendrickx Benoit, Zeltzer Assaf
Brussels, Belgium.
From the Plastic and Reconstructive Surgery and the Radiology Departments, Brussels University Hospital, Vrije Universiteit Brussel.
Plast Reconstr Surg. 2016 Aug;138(2):343-352. doi: 10.1097/PRS.0000000000002347.
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.
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.
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).
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.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
对于腹部供区条件不佳的患者，可采用腰动脉穿支皮瓣进行乳房重建。除了分享腰动脉穿支游离皮瓣乳房重建的临床经验外，作者还对穿支的起源和走行进行了解剖学研究。
利用多排螺旋计算机断层扫描图像观察20例患者中优势腰动脉穿支的位置。对作者行腰动脉穿支皮瓣乳房重建患者的病历也进行了分析。
对20例平均年龄47岁的女性患者进行多排螺旋计算机断层扫描成像显示，优势穿支数量相等（左侧10支，右侧10支）；60%为第三腰动脉穿支，30%为第四腰动脉穿支，其余为第二腰动脉穿支。优势穿支在横突处起源时距y轴主要为42.6mm，在皮下组织穿出时为69.5mm。6例患者成功采用9个腰动脉穿支皮瓣进行乳房重建。平均手术时间为270分钟。由于蒂部较短且腰动脉与胸廓内动脉直径不匹配，50%的病例需要进行血管搭桥（取自腹壁下深血管）。供区的主要并发症为血清肿（80%）。
腰动脉穿支具有恒定的解剖位置。游离腰动脉穿支皮瓣可为乳房重建提供充足的组织；然而，其主要缺点是动脉直径小、蒂部短以及供区血清肿发生率高。
临床问题/证据水平：治疗性，IV级。
