The Lumbar Artery Perforator Free Flap as an Alternative Option for Breast Reconstruction in Low BMI Patients: Analysis of CT Angiography of Donor Sites Across BMI.

IF 2.2 3区 医学 Q2 SURGERY Journal of reconstructive microsurgery Pub Date : 2024-11-21 DOI:10.1055/a-2434-5722
Máire-Caitlin Casey, Anna R Hurley, Minas Chrysopoulo, Aadil Ali Khan, Kieran Power, Theodore Nanidis
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Abstract

Background:  In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition favors the lumbar region over the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI.

Methods:  A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive deep inferior epigastric artery perforator flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI < 22, normal BMI 22 to 24, and high BMI > 30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the LAP.

Results:  A statistically significant difference was identified between the ratio of lumbar-to-abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7 cm lateral to the spinous process (range 6.4-9.5 cm), with no significant difference between BMI groups, highlighting this consistent anatomical position.

Conclusion:  This study confirms a greater lumbar-to-abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 to 9.5 cm lateral to the spinous process. The LAP flap should therefore be strongly considered for autologous breast reconstruction in this patient cohort.

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腰动脉穿孔器游离皮瓣作为低体重指数患者乳房重建的替代选择:不同体重指数供体部位的 CT 血管造影分析。
背景:对于体重指数(BMI)较低的患者,自体乳房重建的选择有限。与腹壁相比,脂肪组织沉积在腰部区域,因此本研究试图将腰动脉穿孔器(LAP)游离皮瓣作为低体重指数导致自体供体部位不足的患者的另一种重建选择:方法: 我们从前瞻性数据库中对本单位进行的所有连续 DIEP 皮瓣乳房再造术进行了回顾性队列分析。随机选择了 100 名体重指数较低的 30 岁患者。对患者的计算机断层扫描进行了分析,以测量腹壁和腰部组织的厚度,并确定腰动脉穿孔的解剖标志关系:结果:BMI组间腰部与腹壁厚度之比差异有统计学意义,低BMI患者的腰部厚度得以保留。第四腰椎穿孔器进入皮下组织的平均距离为棘突外侧 7.7 厘米(范围为 6.4 - 9.5 厘米),BMI 组间无明显差异,突出了这一一致的解剖位置:本研究证实,低体重指数患者的腰腹壁厚度更大,因此体积也更大,其腰椎穿孔解剖位置与棘突外侧的 6.4 - 9.5 厘米一致。因此,在低体重指数患者的自体乳房重建中,应重点考虑腰动脉穿孔器皮瓣。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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