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Lateral Thigh Perforator Flap for Breast Reconstruction: Computed Tomographic Angiography Analysis and Clinical Case
Marco Maricevich, MD, Michael Bykowski, MD, M Asher Schusterman II, MD, Michael Gimbel
University of Pittsburgh
2016-01-29
Presenter: Marco Maricevich, MD
Affidavit:
I certify.
Director Name: Joseph E Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE
While abdominally based flaps are the first choice for autologous breast reconstruction, an alternative donor site is necessary when the abdominal site is unavailable. We propose the lateral thigh region ("saddlebags") as a suitable donor site for select patients.
METHODS
The lateral thigh perforator (LTP) anatomy was studied in 100 preoperative CT angiograms (DIEP protocol) at our institution (200 thighs). Collected data included lateral circumflex femoral artery (LCFA) origin, number/type of LCFA perforators, pedicle vessel diameter and length, perforator course, and reference point measurements. A clinical case using bilateral LTP flaps for breast reconstruction is presented.
RESULTS
LCFA originated from the profunda femoral artery in 83% of thighs. Perforators analyzed originated from the ascending branch of the LCFA (4.6 mm average diameter at origin), averaging 2.6 perforators/thigh. Mean estimated pedicle length was 7.7 cm. Septocutaneous perforators were present in 97% of thighs (1.7 perforators/thigh), emerging mainly through the TFL-gluteus medius muscle posterior septum. Musculocutaneous perforators were present in 64% of thighs (0.9 perforators/thigh). Septocutaneous perforators were always larger than musculocutaneous. The mean distances of ASIS-LCFA origin and ASIS-perforators piercing deep fascia were 12.3 cm and 9.9 cm, respectively. Our LTP flap clinical case featured flap dissection in the supine position, primary donor site closure, and bilateral flap survival.
CONCLUSIONS
Based on CTA analysis, lateral thigh perforators demonstrated consistent anatomy and clinically suitable pedicle length. Septocutaneous perforators were larger, more numerous, and more consistently present. We believe LTP flap represents a reasonable alternative for select patients undergoing autologous breast reconstruction.
