Falinower Hugo, Herlin Christian, Laloze Jérome, Bodin Frédéric, Kerfant Nathalie, Chaput Benoit
Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Institut Claudius-Regaud, Toulouse, France.
Department of Plastic and Reconstructive Surgery, Burns and Wound Healing Units, CHRU Lapeyronie, Montpellier, France.
Plast Reconstr Surg Glob Open. 2020 Jan 24;8(1):e2522. doi: 10.1097/GOX.0000000000002522. eCollection 2020 Jan.
Lumbosacral substance defect is a challenge in reconstructive surgery because few coverage solutions are available in this anatomical region. Lumbar artery perforator flaps (LAPs) have been progressively developed and make it possible to solve very complex situations. We report a multicenter study on LAP performed to treat medium and low lumbar defects of various etiologies, to highlight the versatility of this flap as well as its robustness and reproducibility.
Between 2012 and 2019, 32 LAPs were performed in the Toulouse and Strasbourg University hospitals. Etiologies of the defects encountered were diverse: chronic wounds following neurosurgery, oncodermatology, burn sequelae, and ballistic injury. All LAPs were used in their pedicled form, turned as propeller, and combined or not with other flaps.
We treated 31 patients with 32 LAPs. Average flap size was 14.3 cm (range 8-26) × 6.5 cm (range 5-10), and average arc of rotation was 131.3 degrees (range 70-180 degrees). Only 4 patients (12.9%) presented partial necrosis, but required no other covering procedure because secondary healing was sufficient. No coverage failure was reported. Average follow-up duration was 9.7 months (range 1-18).
In the case of lumbosacral defects of various etiologies, propeller LAP is a reliable and efficient surgical procedure, offering the advantage of low donor site morbidity. The reconstructive surgeon should propose this technique to patients as a first-line option where surgery is indicated.
腰骶部组织缺损在重建手术中是一项挑战，因为该解剖区域可用的覆盖解决方案很少。腰动脉穿支皮瓣（LAP）已逐步发展，使得解决非常复杂的情况成为可能。我们报告一项关于LAP的多中心研究，该研究用于治疗各种病因引起的中低位腰椎缺损，以突出这种皮瓣的多功能性及其稳健性和可重复性。
2012年至2019年期间，图卢兹和斯特拉斯堡大学医院共进行了32例LAP手术。所遇到缺损的病因多种多样：神经外科术后慢性伤口、肿瘤皮肤病学、烧伤后遗症和弹道伤。所有LAP均采用带蒂形式，旋转成推进皮瓣，可与其他皮瓣联合或不联合使用。
我们用32例LAP治疗了31例患者。皮瓣平均大小为14.3厘米（范围8 - 26）×6.5厘米（范围5 - 10），平均旋转弧度为131.3度（范围70 - 180度）。仅4例患者（12.9%）出现部分坏死，但由于二期愈合充分，无需其他覆盖手术。未报告覆盖失败情况。平均随访时间为9.7个月（范围1 - 18）。
对于各种病因引起的腰骶部缺损，推进式LAP是一种可靠且有效的手术方法，具有供区并发症发生率低的优点。重建外科医生应将该技术作为有手术指征患者的一线选择推荐给他们。
