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The transverse lumbar perforator flap: An anatomic and clinical study
Bhagwat S Mathur1, Shaun S Tan2, F A Bhat3
1St Andrew's Centre for Plastic Surgery and Burns, Room E322, Stock Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK; Department of Plastic Surgery, PO Box 2897, Riyadh Medical Complex, Riyadh, 11196, Saudi Arabia.
The contralaterally based transverse lumbar perforator flap offers a reliable solution for complex lumbosacral defects, demonstrating low complication rates and versatility in reconstruction. This technique provides a simple, effective option for managing challenging wounds, even in patients with comorbidities.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Vascular Surgery
Background:
- Lumbosacral defects present significant reconstructive challenges, often requiring vascularized soft tissue for closure.
- Traditional flap methods in this area risk failure due to recurrent tissue breakdown and geometric limitations.
- Ipsilateral lumbar perforator flaps have shown modest reconstructive potential, prompting investigation into alternative approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of the contralateral-based transverse lumbar perforator flap for lumbosacral defect reconstruction.
- To assess the reconstructive potential and reliability of using lumbar artery perforators from the contralateral side.
- To determine the clinical outcomes and complication rates associated with this flap technique.
Main Methods:
- A retrospective analysis of 102 patients with lumbosacral defects reconstructed using contralaterally based transverse lumbar perforator flaps over 20 years.
- Assessment of flap viability, complication rates (necrosis, recurrence), and donor site healing.
- Computed tomographic angiography (CTA) was used to assess lumbar artery perforator anatomy in a subset of patients.
Main Results:
- 102 lumbosacral defects were reconstructed in 102 patients, primarily following pressure ulcer debridement (96 cases).
- Flap tip necrosis occurred in 3% of cases, with no complete flap loss reported.
- Recurrence of defects was observed in two cases (sacral pressure sores), managed with flap advancement or skin grafts.
Conclusions:
- The contralateral-based transverse lumbar perforator flap is a simple, reliable, and versatile option for lumbosacral defect management.
- This technique allows for large flap dimensions (up to 24x15 cm) based on a single lumbar perforator.
- The flap is a reusable choice, offering a robust solution for complex reconstructive problems in challenging anatomical locations.
