Lumbar flap in breast reconstruction (literature review)
https://doi.org/10.52581/1814-1471/88/05
Abstract
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.
About the Authors
О. I. Startseva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
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
М. V. Ermoshenkova
I.M. Sechenov First Moscow State Medical University (Sechenov University); Moscow City Oncological Hospital No. 1, Moscow Healthcare Department
Russian Federation
Russian Federation
Maria V. Ermoshchenkova, Dr. Med. sci., head of the Oncology Department No. 1
bld. 7, 18A, Zagorodnoe sh., Moscow, 117152
A. S. Frolova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
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
S. G. Khanakhyan
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Sirushik S. Khanakhyan, 5th year student, the Faculty of Medicine
bld. 2, 8, Trubetskaya st., Moscow, 119991
М. I. Babushkina
N.I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Marina I. Babushkina – 6th year student, the Pediatric faculty
1, Ostrovityanov st., Moscow, 117997
References
1. Gravvanis 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.0b013e3180de60b7
2. 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.).
3. 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 Apr;44(2):299-306. https://doi.org/10.1007/s00266-019-01554-8
4. Jo 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-0041-1727200
5. Hummelink 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.0000000000005614
6. Hill 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: 353842
7. Kroll 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.
8. 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;52(7):541-6. doi: 10.1054/bjps.1999.3120. PMID: 10658107
9. de 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: 12041981
10. de 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: 12791371
11. Peters 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.2015.03.031
12. 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.).
13. Sbitany H. Breast Reconstruction. Surg Clin North Am. 2018 Aug;98(4):845-57. https://doi.org/10.1016/ j.suc.2018.03.011
14. Schaffer 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.0000000000002399
15. Haddock 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.0000000000010830
16. Prabhu 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.2022.11.006
17. Peled 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.2022.11.006
18. Afsharfard 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.2021.01.016
19. Hidaka 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.0000000000003305
20. Zhao 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.2021.01.016
21. Haddock 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.2022.10.008
22. Murota 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.2022.10.008
23. 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.).
24. 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;38:45-51. https://doi.org/10.1016/j.breast.2017.12.003
25. Opsomer 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.0000000000006681
26. Haddock 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.0000000000002800
27. Haddock 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.0000000000011002
28. Sultan 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.2022.11.005
29. Vonu 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.
30. 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;47(9):2272-85. https://doi.org/10.1016/j.ejso.2021.05.006
Review
For citations:
Startseva О.I., Ermoshenkova М.V., Frolova A.S., Khanakhyan S.G., Babushkina М.I. Lumbar flap in breast reconstruction (literature review). Issues of Reconstructive and Plastic Surgery. 2024;27(1):51-60. (In Russ.) https://doi.org/10.52581/1814-1471/88/05
Views:
377
Email this article 