Advertisement

European Journal of Plastic Surgery

, Volume 42, Issue 2, pp 201–204 | Cite as

Deep circumflex iliac artery perforator flap: a new option for reconstruction of lumbosacral defects

  • Mustafa AkyurekEmail author
  • Mark Albert
Case Report
  • 18 Downloads

Abstract

Reconstruction of lower back defects is challenging. Since primary repair is often not possible to achieve, there is a need for local or regional flap transfer. This report presents a new technique of reconstruction of lumbosacral defects by deep circumflex iliac artery perforator skin flap based on a propeller flap design. A lower back scar contracture and contour deformity in a 10-year-old female patient required excision and flap reconstruction. Deep circumflex iliac artery perforator flap was marked in the groin region as an elliptical skin paddle and dissected as an island flap based on a dominant musculocutaneous perforator. Following creation of the lumbosacral defect, reconstruction was accomplished by flap rotation based on a propeller flap design around the perforator. Donor site was closed primarily in layers. Complete flap survival was noted with uneventful recovery. Revision was later performed for flap debulking and contour restoration with pleasing result at 1 year. Deep circumflex iliac artery perforator flap can be utilized for lower back defect reconstruction by means of a propeller flap design. It is offered as a new flap option for lumbosacral reconstruction. The technique allows well-vascularized tissue transfer while accomplishing primary closure of the donor site with easily hidden scar. The disadvantages include tedious dissection as well as absence of a dominant perforator in some cases.

Level of Evidence: Level V, therapeutic study.

Keywords

Lumbosacral Back Reconstruction Flap Deep circumflex iliac artery perforator 

Notes

Compliance with ethical standards

Funding

None.

Conflict of interest

Mustafa Akyurek and Mark Albert declare that they have no conflict of interest.

Ethical approval

This research involved a human participant and accepted principles of ethical and professional conduct was followed.

Informed consent

A written informed consent was obtained from the patient and filed.

Supplementary material

Video 1

DCIA perforator skin flap rotation to lower back defect based on propeller flap design. (MOV 6546 kb)

References

  1. 1.
    Mathis DW, Thornton JF, Rohrich RJ (2006) Management of posterior trunk defects. Plast Reconstr Surg 118:73e–83eCrossRefGoogle Scholar
  2. 2.
    Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD (2003) Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 28:1203–1211Google Scholar
  3. 3.
    Wilhelmi BJ, Snyder N, Colquhoun T et al (2000) Bipedicle paraspinous muscle flaps for spinal wound closure. Plast Reconstr Surg 106:1305–1311CrossRefGoogle Scholar
  4. 4.
    Nojima K, Brown SA, Acikel C, Janis J, Arbique G, Abulezz T, Gao J, Wen Q, Kurihara K, Rohrich RJ (2006) Defining vascular supply and territory of thinned perforator flaps: part II. Superior gluteal artery perforator flap. Plast Reconstr Surg 118:1338–1348CrossRefGoogle Scholar
  5. 5.
    O’Shaughnessy BA, Dumanian GA, Liu JC, Ganju A, Ondra SL (2007) Pedicled omental flaps as an adjunct in complex spine surgery. Spine 32:3074–3080CrossRefGoogle Scholar
  6. 6.
    Glass BS, Disa JJ, Mehrara BJ et al (2006) Reconstruction of extensive partial or total sacractomy defects with a transabdominal vertical rectus abdominis myocutaneous flap. Ann Plast Surg 56:526–530CrossRefGoogle Scholar
  7. 7.
    Duffy FJ, Weprin BE, Swift DM (2004) A new approach to closure of large lumbosacral myelomeningoceles: the superior gluteal artery perforator flap. Plast Reconstr Surg 114:1864–1868CrossRefGoogle Scholar
  8. 8.
    Arkudas A, Horch RE, Reus S et al (2018) Retrospective cohort study of combined approach for trunk reconstruction using arteriovenous loops and free flaps. J Plast Reconstr Aesthet Surg 71:394–401CrossRefGoogle Scholar
  9. 9.
    Mathur BS, Tan SS, Bhat FA, Rozen WM (2016) The transverse lumbar perforator flap: an anatomic and clinical study. J Plast Reconstr Aesthet Surg 69:770–776CrossRefGoogle Scholar
  10. 10.
    Park HS, Morrison E, Lo C, Leong J (2016) An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg 77:332–336CrossRefGoogle Scholar
  11. 11.
    de Fontaine S, Gaede F, Berthe JV (2008) The reverse turnover latissimus dorsi flap for closure of midline lumbar defects. J Plast Reconstr Aesthet Surg 61:917–924CrossRefGoogle Scholar
  12. 12.
    Hamdi M, Craggs B, Brussaard C, Seidenstueker K, Hendrickx B, Zeltzer A (2016) Lumbar artery perforator flap: an anatomical study using multidetector computed tomographic scan and surgical pearls for breast reconstruction. Plast Reconstr Surg 138:343–352CrossRefGoogle Scholar
  13. 13.
    Bissell MB, Greenspun DT, Levine J, Rahal W, al-Dhamin A, AlKhawaji A, Morris SF (2016) The lumbar artery perforator flap: 3-dimensional anatomical study and clinical applications. Ann Plast Surg 77:469–476CrossRefGoogle Scholar
  14. 14.
    McGregor IA, Jackson IT (1972) The groin flap. Br J Plast Surg 25:3–16CrossRefGoogle Scholar
  15. 15.
    Akyurek M, Conejero A, Dunn R (2008) Deep circumflex iliac artery perforator flap without iliac crest. Plast Reconstr Surg 122:1790–1795CrossRefGoogle Scholar
  16. 16.
    Teo TC (2010) The propeller flap concept. Clin Plast Surg 37:615–626CrossRefGoogle Scholar
  17. 17.
    Taylor GI, Townsend P, Corlett R (1979) Superiority of the deep circumflex iliac vessels as the supply for groin flaps: clinical work. Plast Reconstr Surg 64:745–759CrossRefGoogle Scholar
  18. 18.
    Safak T, Klebuc MJ, Mavili E, Shenaq SM (1997) A new design of the iliac crest microsurgical free flap without including the obligatory muscle cuff. Plast Reconstr Surg 100:1703–1709CrossRefGoogle Scholar
  19. 19.
    Taylor GI, Townsend P, Corlett R (1979) Superiority of the deep circumflex iliac vessels as the supply for groin flaps: experimental work. Plast Reconstr Surg 64:595–604CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Plastic SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations