The lumbar artery perforator based island flap: anatomical study and case reports

A lumbar artery island flap can be elevated based on a single lumbar artery. We studied the vascular anatomy using 21 specimens of lumbar arteries in 11 cadavers, and investigated the skin territory of the artery using fluorescein injection. We observed lumbar perforators emerging through the lumbar fascia at the lateral border of the erector spinae muscle, situated 5-9 cm from the midline. The diameter of the vascular bundle at the site of perforation ranged from 1 to 5 mm. Perforators of the second and fourth lumbar arteries were much more developed than others. The cutaneous territory supplied by the second lumbar artery extended from the posterior midline to the lateral border of the rectus sheath, and at least 10 cm above the anterosuperior iliac spine. We transferred four clinical flaps for coverage of ulcers on the lower back. All flaps survived and their donor site defects were closed primarily. The cadaver dissection, the injection study and our clinical success have confirmed the feasibility of lumbar artery island flaps.