plasurВопросы реконструктивной и пластической хирургииIssues of Reconstructive and Plastic Surgery1814-1471АНО "НИИ микрохирургии"10.52581/1814-1471/88/05plasur-237Research ArticleПЛАСТИЧЕСКАЯ ХИРУРГИЯPLASTIC SURGERYПоясничный лоскут в реконструкции молочной железы (обзор литературы)Lumbar flap in breast reconstruction (literature review)https://orcid.org/0000-0001-9778-2624СтарцеваО. И.StartsevaО. I.

Старцева Олеся Игоревна –д-р мед. наук, профессор кафедры онкологии, радиотерапии и реконструктивной хирургии Института клинической медицины

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Olesya I. Startseva, Dr. Med. sci., Professor, the Department of Oncology, Radiotherapy and Reconstructive Surgery, the Institute of Clinical Medicine

bld. 2, 8, Trubetskaya st., Moscow, 119991

ostarceva@mail.ruhttps://orcid.org/0000-0002-4178-9592ЕрмощенковаМ. В.ErmoshenkovaМ. V.

Ермощенкова Мария Владимировна – д-р мед. наук, зав. онкологическим отделением № 1

117152, г. Москва, Загородное шоссе, д. 18А, стр. 7

Maria V. Ermoshchenkova, Dr. Med. sci., head of the Oncology Department No. 1

bld. 7, 18A, Zagorodnoe sh., Moscow, 117152

maryerm@mail.ruhttps://orcid.org/0000-0002-0652-7474ФроловаА. С.FrolovaA. S.

Фролова Александра Сергеевна – клинический ординатор кафедры онкологии, радиотерапии и реконструктивной хирургии Института клинической медицины

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Alexandra S. Frolova, clinical resident, the Department of Oncology, Radiotherapy and Reconstructive Surgery, the Institute of Clinical Medicine

bld. 2, 8, Trubetskaya st., Moscow, 119991

frolovaaleksa2905@gmail.ruhttps://orcid.org/0000-0003-3201-7061ХанахянС. Г.KhanakhyanS. G.

Ханахян Сирушик Седраковна – студентка 5-го курса лечебного факультета

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Sirushik S. Khanakhyan, 5th year student, the Faculty of Medicine

bld. 2, 8, Trubetskaya st., Moscow, 119991

aleksa2905@mail.ruhttps://orcid.org/0009-0003-3133-3625БабушкинаМ. И.BabushkinaМ. I.

Бабушкина Марина Игоревна – студентка 6-го курса педиатрического факультета 

117997, г. Москва, ул. Островитянова, д. 1

Marina I. Babushkina – 6th year student, the Pediatric faculty

1, Ostrovityanov st., Moscow, 117997

aleksa2905@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет); ГБУЗ «Городская клиническая онкологическая больница № 1» Департамента здравоохранения г. МосквыРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow City Oncological Hospital No. 1, Moscow Healthcare DepartmentRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияN.I. Pirogov Russian National Research Medical UniversityRussian Federation2024300420242715160Copyright © Старцева О.И., Ермощенкова М.В., Фролова А.С., Ханахян С.Г., Бабушкина М.И., 20242024Старцева О.И., Ермощенкова М.В., Фролова А.С., Ханахян С.Г., Бабушкина М.И.Startseva О.I., Ermoshenkova М.V., Frolova A.S., Khanakhyan S.G., Babushkina М.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://plasur.elpub.ru/jour/article/view/237

В настоящее время появляется все большее количество инноваций в реконструктивной хирургии, и одной из таких стало применение альтернативных лоскутов в реконструкции молочной железы (МЖ). Ввиду определенных противопоказаний для использования привычных лоскутов, появляются новые лоскуты, таковым в настоящее время стал лоскут на перфорантных поясничных артериях (LAP-лоскут).

Было проанализировано 23 статьи, описывающие LAP-лоскут и его применение для реконструкции МЖ. В пяти статьях описан опыт применения поясничного лоскута в реконструкции МЖ, в двух – двусторонняя реконструкция с помощью LAP-лоскута, пять исследований были посвящены технике забора и топографической анатомии лоскута.

В данной статье сделан вывод о том, что LAP-лоскут является альтернативным вариантом аутологичной реконструкции МЖ ввиду своих анатомических особенностей, качества подкожной жировой клетчатки и техники забора. Однако для более детального изучения рассматриваемого вопроса необходимо проведение рандомизированных клинических исследований для выявления результатов, количества осложнений и применимости техники в клинической практике.

Currently, there is an increasing number of innovations in reconstructive surgery, one of these was the use of alternative flaps in breast reconstruction. Due to certain contraindications for the use of the usual flaps, one of these has now become a flap on the perforant lumbar arteries or LAP flap. 23 articles describing the LAP flap and its use for breast reconstruction were analyzed.

Five articles describe the experience of using a lumbar flap in breast reconstruction, two articles describe bilateral reconstruction using a LAP flap, five studies describe the technique of sampling and the topographic anatomy of the flap.

The presented article concludes that the LAP flap is an alternative option for autologous breast reconstruction according to research data due to its anatomical features, the quality of subcutaneous fat and sampling techniques. However, for a more detailed study of the issue under consideration, it is necessary to conduct randomized clinical trials to identify the results, the number of complications and the applicability of the technique in clinical practice.

реконструкция молочной железыLAP-лоскутрак молочной железыbreast reconstructionLAP flapbreast cancerReferencesGravvanis A., Niranjan N.S. Retrograde dissection of the vascular pedicle of deep inferior epigastric artery perforator (DIEAP) flap // Ann Plast Surg. 2008. Vol. 60, No. 4. P. 395–397. https://doi.org/10.1097/sap.0b013e3180de60b7Gravvanis A., Niranjan N.S. Retrograde dissection of the vascular pedicle of deep inferior epigastric artery perforator (DIEAP) flap. Ann Plast Surg. 2008 Apr;60(4):395-397. https://doi.org/10.1097/sap.0b013e3180de60b7Синельников М.Е, Старцева О.И, Мельников Д.В., Иванов С.И. Микрососудистые аспекты реваскуляризации перфорантного нижнего эпигастрального лоскута при реконструкции молочных желез // Сеченовский вестник. 2019. Т. 10, №3. С. 22–29.Sinelnikov M.E., Starceva O.I., Melnikov D.V., Ivanov S.I. Mikrososudistye aspekty revaskulyarizacii perforantnogo nizhnego epigastral'nogo loskuta pri rekonstrukcii molochnyh zhelez [Microvascular aspects of deep inferior epigastric perforator flap revascularization in breast reconstruction]. Sechenovskiy vestnik – Sechenov Medical Journal. 2019;10(3):22-29 (In Russ.).Grünherz L., Wolter A., Andree C., Grüter L., Staemmler K., Munder B., et al. Autologous Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases // Aesthetic Plast Surg. 2020. Vol. 44, No. 2. P. 299–306. https://doi.org/10.1007/s00266-019-01554-8Grünherz L., Wolter A., Andree C., Grüter L., Staemmler K., Munder B., et al. Autologous Breast Reconstruction with SIEA Flaps: An Alternative in Selected Cases. Aesthetic Plast Surg. 2020 Apr;44(2):299-306. https://doi.org/10.1007/s00266-019-01554-8Jo T., Jeon D.N., Han H.H. The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients // J Reconstr Microsurg. 2022 Jan. Vol. 38, No. 1. P. 27–33. https://doi.org/10.1055/s-0041-1727200Jo T., Jeon D.N., Han H.H. The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients. J Reconstr Microsurg. 2022 Jan;38(1):27-33. https://doi.org/10.1055/s-0041-1727200Hummelink S., Hoogeveen Y.L., Schultze Kool L.J., Ulrich D.J.O. A New and Innovative Method of Preoperatively Planning and Projecting Vascular Anatomy in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial // Plast Reconstr Surg. 2019 Jun. Vol. 143, No. 6. P. 1151e–1158e. https://doi.org/10.1097/prs.0000000000005614Hummelink S., Hoogeveen Y.L., Schultze Kool L.J., Ulrich D.J.O. A New and Innovative Method of Preoperatively Planning and Designing Vascular Anatomy in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial. Plast Reconstr Surg. 2019 Jun;143(6):1151e-8e. https://doi.org/10.1097/prs.0000000000005614Hill H.L., Brown R.G., Jurkiewicz M.J. The transverse lumbosacral back flap // Plast Reconstr Surg. 1978 Aug. Vol. 62, No. 2. P. 177–184. doi: 10.1097/00006534-197808000-00005. PMID: 353842Hill H.L., Brown R.G., Jurkiewicz M.J. The transverse lumbosacral back flap. Plast Reconstr Surg. 1978 Aug; 62(2):177-84. doi: 10.1097/00006534-197808000-00005. PMID: 353842Kroll S.S., Rosenfield L. Perforator-based flaps for low posterior midline defects // Plast Reconstr Surg. – 1988 Apr. Vol. 81, No. 4. P. 561–566. doi: 10.1097/00006534-198804000-00012. PMID: 3279442Kroll S.S., Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg. 1988 Apr; 81(4):561-6. doi: 10.1097/00006534-198804000-00012. PMID: 3279442.Kato H., Hasegawa M., Takada T., Torii S. The lumbar artery perforator based island flap: anatomical study and case reports // Br J Plast Surg. 1999 Oct. Vol. 52, No. 7. Р. 541–546. doi: 10.1054/bjps.1999.3120. PMID: 10658107Kato H., Hasegawa M., Takada T., Torii S. The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg. 1999 Oct;52(7):541-6. doi: 10.1054/bjps.1999.3120. PMID: 10658107de Weerd L., Weum S. The butterfly design: coverage of a large sacral defect with two pedicled lumbar artery perforator flaps // Br J Plast Surg. 2002 Apr. Vol. 55, No. 3. P. 251–253. doi: 10.1054/bjps.2002.3791. PMID: 12041981de Weerd L., Weum S. The butterfly design: coverage of a large sacral defect with two pedicled lumbar artery perforator flaps. Br J Plast Surg. 2002 Apr;55(3):251-3. doi: 10.1054/bjps.2002.3791. PMID: 12041981de Weerd L., Elvenes O.P., Strandenes E., Weum S. Autologous breast reconstruction with a free lumbar artery perforator flap // Br J Plast Surg. 2003 Mar. Vol. 56, No. 2. P. 180–183. doi: 10.1016/s0007-1226(03)00039-0. PMID: 12791371de Weerd L., Elvenes O.P., Strandenes E., Weum S. Autologous breast reconstruction with a free lumbar artery perforator flap. Br J Plast Surg. 2003 Mar;56(2):180-3. doi: 10.1016/s0007-1226(03)00039-0. PMID: 12791371Peters K.T., Blondeel P.N., Lobo F., van Landuyt K. Early experience with the free lumbar artery perforator flap for breast reconstruction // Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015 Aug. Vol. 68, No. 8. P. 1112–1119. https://doi.org/10.1016/j.bjps.2015.03.031Peters K.T., Blondeel P.N., Lobo F., van Landuyt K. Early experience with the free lumbar artery perforator flap for breast reconstruction // Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015 Aug;68(8):1112-9. https://doi.org/10.1016/j.bjps.2015.03.031Кулишов В.А., Рогажискас П.В. Сравнительный анализ эффективности оперативных технологий реконструкции молочной железы после мастэктомии // Медицина и образование в Сибири. 2007. №2. С. 6.Kulishov V.A., Rogazhiskas P.V. Sravnitel'nyi analiz effektivnosti operativnyh tekhnologiy rekonstrukcii molochnoy zhelezy posle mastektomii [Comparative analysis of the effectiveness of surgical technologies for breast reconstruction after mastectomy]. Meditsina i obrazovaniye v Sibiri. 2007;2:6 (In Russ.).Sbitany H. Breast Reconstruction // Surg Clin North Am. 2018 Aug. Vol. 98, No. 4. P. 845–857. https://doi.org/10.1016/j.suc.2018.03.011Sbitany H. Breast Reconstruction. Surg Clin North Am. 2018 Aug;98(4):845-57. https://doi.org/10.1016/ j.suc.2018.03.011Schaffer C., Guillier D., Raffoul W., di Summa P.G. Lumbar Perforator Flaps for Coverage of Extensive Defects With Osteomyelitis // Ann Plast Surg. 2021 Jan. Vol. 86, No. 1. P. 67–71. https://doi.org/10.1097/sap.0000000000002399Schaffer C., Guillier D., Raffoul W., di Summa P.G. Lumbar Perforator Flaps for Coverage of Extensive Defects With Osteomyelitis. Ann Plast Surg. 2021 Jan;86(1):67-71. https://doi.org/10.1097/sap.0000000000002399Haddock N.T., Ercan A., Teotia S.S. Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility // Plast Reconstr Surg. 2023 June 19. https://doi.org/10.1097/prs.0000000000010830Haddock N.T., Ercan A., Teotia S.S. Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility. Plast Reconstr Surg. 2023 June 19. https:// doi.org/10.1097/prs.0000000000010830Prabhu S.S., Driscoll C.R., Davidson A.L., Peoples A.E., Katz A.J. The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction // J Plast Reconstr Aesthet Surg. 2022 Nov. Vol. 77. P. 1–7. https://doi.org/10.1016/j.bjps.2022.11.006Prabhu S.S., Driscoll C.R., Davidson A.L., Peoples A.E., Katz A.J. The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction. J Plast Reconstr Aesthet Surg. 2022 Nov;77:1-7. https://doi.org/10.1016/j.bjps.2022.11.006Peled A.W., Clavin N.W. Novel Approaches to Breast Reconstruction // Surg Clin North Am. 2023 Feb. Vol. 103, No. 1. P. 141–153. https://doi.org/10.1016/j.bjps.2022.11.006Peled A.W., Clavin N.W. Novel Approaches to Breast Reconstruction. Surg Clin North Am. 2023 Feb; 103(1):141-53.https://doi.org/10.1016/j.bjps.2022.11.006Afsharfard A., Ebrahimibagha H., Zeinalpour A. A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery // Clin Breast Cancer. 2021 Aug. Vol. 21, No. 4. P. e448-53. https://doi.org/10.1016/j.clbc.2021.01.016Afsharfard A., Ebrahimibagha H., Zeinalpour A. A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery. Clin Breast Cancer. 2021 Aug;21(4):e448-53. https://doi.org/10.1016/j.clbc.2021.01.016Hidaka T., Mori H., Shimizu H., Takahashi S., Tanaka K., Okazaki M. Comparison of Lumbar Artery and Superior Gluteal Artery Perforator Flaps for Breast Reconstruction: Multislice CT-Based Anatomical Study // Annals of Plastic Surgery. 2022 Dec. Vol. 89. P. e39–44. https://doi.org/10.1097/sap.0000000000003305Hidaka T., Mori H., Shimizu H., Takahashi S., Tanaka K., Okazaki M. Comparison of Lumbar Artery and Superior Gluteal Artery Perforator Flaps for Breast Reconstruction: Multislice CT-Based Anatomical Study. Annals of Plastic Surgery. 2022 Dec;89:e39-44. https://doi.org/10.1097/sap.0000000000003305Zhao R., Zhang X., Yang X., Zhao Z. Modified fourth lumbar artery local perforator flap: an alternative for reconstruction of nonhealing lumbosacral spinal defects // BMC Surg. 2023 Jan. Vol. 23, No. 1. P. 10. https://doi.org/10.1016/j.clbc.2021.01.016Zhao R., Zhang X., Yang X., Zhao Z. Modified fourth lumbar artery local perforator flap: an alternative for reconstruction of nonhealing lumbosacral spinal defects. BMC Surg. 2023 Jan;23(1):10. https://doi.org/10.1016/j.clbc.2021.01.016Haddock N.T., Teotia S.S. Modern Approaches to Alternative Flap-Based Breast Reconstruction: Stacked Flaps // Clinics in Plastic Surgery. 2023 Apr. Vol. 50, No. 2. P. 325–335. https://doi.org/10.1016/j.cps.2022.10.008Haddock N.T., Teotia SS. Modern Approaches to Alternative Flap-Based Breast Reconstruction: Stacked Flaps. Clinics in Plastic Surgery. 2023 Apr;50(2):325-35. https://doi.org/10.1016/j.cps.2022.10.008Murota Y., Satake T., Tsunoda Y., Muto M., Koike T., et al. Stacked deep inferior epigastric perforator with sequential lumbar artery perforator flaps for bilateral breast reconstruction: A case report // Microsurgery. 2022 Nov. Vol. 42, No. 8. P. 829–834. https://doi.org/10.1016/j.cps.2022.10.008Murota Y., Satake T., Tsunoda Y., Muto M., Koike T., et al. Stacked deep inferior epigastric perforator with sequential lumbar artery perforator flaps for bilateral breast reconstruction: A case report. Microsurgery. 2022 Nov;42(8):829-834. https://doi.org/10.1016/j.cps.2022.10.008Теличко С.В., Коваленко Н.В., Жаворонкова В.В., Иванов А.И., Сухов В.А., Сперанский Д.Л., Девятченко Т.Ф., Чухнин А.Г. Современные методы реконструкции молочной железы. Собственный опыт // Вестник Волгоградского государственного медицинского университета. 2020. Т. 17, №3 (75). С. 179–184.Telichko S.V., Kovalenko N.V., Zhavoronkova V.V., Ivanov A.I., Sukhov V.A., Speranskiy D.L., Devyatchenko T.F., Chukhnin A.G. Sovremennye metody rekonstrukcii molochnoy zhelezy. Sobstvennyi opyt [Modern methods of breast reconstruction. Own experience] Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta – Journal of Volgograd State Medical University. 2020; 3(75):179-84 (In Russ.).Jeong W., Lee S., Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps // Breast. 2018 Apr. Vol. 38. P. 45–51. https://doi.org/10.1016/j.breast.2017.12.003Jeong W., Lee S., Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. Breast. 2018 Apr;38:45-51. https://doi.org/10.1016/j.breast.2017.12.003Opsomer D., Vyncke T., Depypere B., Stillaert F., Blondeel P., Van Landuyt K. Lumbar Flap versus the Gold Standard: Comparison to the DIEP Flap // Plast Reconstr Surg. 2020 Apr. Vol. 145, No. 4. P. 706e–714e. https://doi.org/10.1097/prs.0000000000006681Opsomer D., Vyncke T., Depypere B., Stillaert F., Blondeel P., Van Landuyt K. Lumbar Flap versus the Gold Standard: Comparison to the DIEP Flap. Plast Reconstr Surg. 2020 Apr;145(4):706e-714e. https://doi.org/10.1097/prs.0000000000006681Haddock N., Teotia S. Lumbar Artery Perforator Flap: Initial Experience with Simultaneous Bilateral Flaps for Breast Reconstruction // Plastic and Reconstructive Surgery Global Open. May 1, 2020. Publish Ahead of Print:1. https://doi.org/10.1097/gox.0000000000002800Haddock N., Teotia S. Lumbar Artery Perforator Flap: Initial Experience with Simultaneous Bilateral Flaps for Breast Reconstruction. Plastic and Reconstructive Surgery – Global Open. May 1, 2020. Publish Ahead of Print:1. https://doi.org/10.1097/gox.0000000000002800Haddock N.T., Lakatta A.C., Teotia S.S. Bilateral LAP Flaps for Breast Reconstruction: A Perforator Classification System // Plast Reconstr Surg. Aug 18, 2023. https://doi.org/10.1097/prs.0000000000011002Haddock N.T., Lakatta A.C., Teotia S.S. Bilateral LAP Flaps for Breast Reconstruction: A Perforator Classification System. Plast Reconstr Surg. Aug 18, 2023. https://doi.org/10.1097/prs.0000000000011002Sultan S.M., Greenspun D.T. Lumbar Artery Perforator Flaps in Autologous Breast Reconstruction // Clin Plast Surg. 2023 Apr. Vol. 50, No. 2. P. 301-312. https://doi.org/10.1016/j.cps.2022.11.005Sultan S.M., Greenspun D.T. Lumbar Artery Perforator Flaps in Autologous Breast Reconstruction. Clin Plast Surg. 2023 Apr;50(2):301-12. https://doi.org/10.1016/j.cps.2022.11.005Vonu P.M., Chopan M., Sayadi L., Chim H.W., Leyngold M. Lumbar Artery Perforator Flaps: A Systematic Review of Free Tissue Transfers and Anatomical Characteristics // Ann Plast Surg. 2022 Oct. Vol. 89, No. 4. P. 465–471. doi: 10.1097/SAP.0000000000003216. Epub 2022 Apr 23. PMID: 35502957Vonu P.M., Chopan M., Sayadi L., Chim H.W., Leyngold M. Lumbar Artery Perforator Flaps: A Systematic Review of Free Tissue Transfers and Anatomical Characteristics. Ann Plast Surg. 2022 Oct;89(4):465-471. doi: 10.1097/SAP.0000000000003216. Epub 2022 Apr 23. PMID: 35502957.Gilmour A, Cutress R, Gandhi A, Harcourt D, Little K, et al. Oncoplastic breast surgery: A guide to good practice // Eur J Surg Oncol. 2021 Sep. Vol. 47, No. 9. P. 272–285. https://doi.org/10.1016/j.ejso.2021.05.006Gilmour A., Cutress R., Gandhi A., Harcourt D., Little K., et al.. Oncoplastic breast surgery: A guide to good practice. Eur J Surg Oncol. 2021 Sep;47(9):2272-85. https://doi.org/10.1016/j.ejso.2021.05.006

The authors declare that there are no conflicts of interest present.