The Vascular Basis of Perforator Flaps Based on the Source Arteries of the Lateral Lumbar Region

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Background:Perforator flaps based on the integument of the trunk have been well described in the literature; however, the anatomy of many donor sites has yet to be adequately documented. The integument of the lateral lumbar region of the trunk is supplied by a number of source arteries (lower posterior intercostal, lumbar, superior epigastric, deep inferior epigastric, superficial inferior epigastric, superficial circumflex iliac, deep circumflex iliac) whose large perforators may be suitable for perforator flap harvest. The purpose of the current study was to describe the vascular anatomy of these perforators in the lateral lumbar region.Methods:A series of five fresh human cadavers were studied using a lead oxide–gelatin injection technique. The integument of the trunk (10 sides or hemitrunk specimens) was dissected, and the perforating vessels (diameter ≥0.5 mm) were identified, noting vascular origin, diameter, and pedicle length. Radiographs of tissue specimens were digitally analyzed using the software Scion Image for Windows (Scion Corp., Frederick, Md.) to determine vascular territories.Results:The source vessels contributed a summed mean of 33 perforators per hemitrunk, with a mean emerging vessel diameter of 0.7 ± 0.2 mm and a corre- sponding mean superficial pedicle length of 31 ± 24 mm. The total area of skin supplied directly by these 33 perforators was 1200 cm2, equating to a mean area of 37 cm2 per perforator.Conclusion:The authors have comprehensively described the anatomy of perforators of the lateral lumbar region of the trunk.

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