Sommeling Casper Emile, Colebunders Britt, Pardon Heleen E, Stillaert Filip B, Blondeel Phillip N, van Landuyt Koenraad
a Department of Plastic & Reconstructive Surgery , Ghent University Hospital , Ghent , Belgium.
Acta Chir Belg. 2017 Aug;117(4):223-226. doi: 10.1080/00015458.2017.1284431. Epub 2017 Feb 28.
The free lumbar artery perforator flap has recently been introduced as a potentially valuable option for autologous breast reconstruction in a subset of patients. Up to date, few anatomical studies, exploring the lumbar region as a donor site for perforator- based flaps, have been conducted.
An anatomical study of the position of the dominant lumbar artery perforator was performed, using the preoperative computed tomographic angiography images of 24 autologous breast reconstruction patients. In total, 61 dominant perforators were determined, 28 on the left and 33 on the right side. A radiologist defined the position of the perforator as coordinates in an xy-grid.
Dominant perforators were shown to originate from the lumbar arteries at the level of lumbar vertebrae three or four. Remarkably, approximately 85% of these lumbar artery perforators enter the skin at 7-10 cm lateral from the midline (mean left 8.6 cm, right 8.2 cm).
This study concludes a rather constant position of the dominant perforator. Therefore, preoperative-computed tomographic angiography is not always essential to find this perforator and Doppler ultrasound could be considered as an alternative, thereby carefully assessing all advantages and disadvantages inherent to either of these imaging methods.
游离腰动脉穿支皮瓣最近被引入，作为一部分患者自体乳房重建的潜在有价值的选择。迄今为止，很少有解剖学研究将腰部作为穿支皮瓣的供区进行探索。
利用24例自体乳房重建患者的术前计算机断层血管造影图像，对优势腰动脉穿支的位置进行了解剖学研究。总共确定了61个优势穿支，左侧28个，右侧33个。一名放射科医生将穿支的位置定义为xy网格中的坐标。
优势穿支显示起源于第三或第四腰椎水平的腰动脉。值得注意的是，这些腰动脉穿支中约85%在距中线外侧7-10厘米处进入皮肤（左侧平均8.6厘米，右侧平均8.2厘米）。
本研究得出优势穿支位置相当恒定的结论。因此，术前计算机断层血管造影并非总是找到该穿支所必需的，可考虑将多普勒超声作为替代方法，从而仔细评估这两种成像方法各自固有的所有优缺点。
