From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2024 Sep 1;154(3):413e-420e. doi: 10.1097/PRS.0000000000011002. Epub 2023 Aug 18.
Autologous breast reconstruction is continually evolving, with focus on the ideal donor site. This study presents 108 consecutive simultaneous lumbar artery perforator (LAP) flaps and a perforator classification system.
A retrospective review of all LAP flaps was completed, and appropriate data were recorded. All simultaneous bilateral LAP flaps were included, and perforator patterns were assessed using CT angiography (CTA).
Fifty-four patients (108 flaps) were included in the final review. The mean patient age was 50.7 years, and the mean body mass index was 26.6. Mean ischemia times for all flaps and grafts were 130 ± 64.5 and 300.6 ± 97.3 minutes, respectively. The average pedicle length was 4.6 ± 1.5 cm, and the average composite graft length was 6.2 ± 1.7 cm. Donor-site complications consisted of seromas (10 patients [19%]), hematomas (6 patients [11%]), procedural wounds (4 patients [8%]), and infections (2 patients [4%]). The total flap loss rate was 2.8%. Perforators were classified into categories based on pedicle pattern, lumbar spine level, and clusters, all in relation to posterior iliac bone as seen per CTA. Vascular pedicle patterns were categorized as type 1 (43.9%), 2 (45.6%), 3 (8.8%), or 4 (1.8%). Perforators were dissected at lumbar spine level L3 in 51.8% of patients, L4 in 46.5%, and L5 in 1.8%.
The authors present a CTA-directed anatomic perforator classification system to assist in preoperative planning, dissection, and choice of the composite graft best suited for particular perforator patterns or calibers. Simultaneous LAP flaps can be performed successfully with excellent outcomes in cases unsuitable for other flaps.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自体乳房重建术在不断发展，重点是理想的供区。本研究介绍了 108 例连续的腰动脉穿支（LAP）皮瓣和一种穿支分类系统。
对所有 LAP 皮瓣进行回顾性分析，并记录适当的数据。所有同时进行的双侧 LAP 皮瓣均包括在内，并使用 CT 血管造影（CTA）评估穿支模式。
最终共纳入 54 例患者（108 个皮瓣）进行回顾性分析。患者平均年龄为 50.7 岁，平均 BMI 为 26.6。所有皮瓣和移植物的平均缺血时间分别为 130±64.5 分钟和 300.6±97.3 分钟。蒂长平均为 4.6±1.5cm，复合移植物长度平均为 6.2±1.7cm。供区并发症包括血清肿（10 例[19%]）、血肿（6 例[11%]）、手术切口（4 例[8%]）和感染（2 例[4%]）。总的皮瓣失效率为 2.8%。穿支根据蒂的模式、腰椎水平和 CT 血管造影（CTA）所见的髂后骨簇进行分类，分为 4 种类型。血管蒂模式分为 1 型（43.9%）、2 型（45.6%）、3 型（8.8%）或 4 型（1.8%）。51.8%的患者在腰椎 L3 水平解剖穿支，46.5%在 L4 水平，1.8%在 L5 水平。
作者提出了一种 CTA 引导的解剖穿支分类系统，以协助术前规划、解剖和选择最适合特定穿支模式或口径的复合移植物。对于不适合其他皮瓣的病例，可以成功进行同时进行的 LAP 皮瓣，且效果良好。
临床问题/证据水平：治疗性，IV 级。
