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The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

Tuinder, Stefania M., H., M.D., Ph.D.; Beugels, Jop, M.D.; Lataster, Arno, M.Sc.; de Haan, Michiel, W., M.D., Ph.D.; Piatkowski, Andrzej, M.D., Ph.D.; Saint-Cyr, Michel, M.D.; van der Hulst, René R. W., J., M.D., Ph.D.; Allen, Robert, J., M.D.

Plastic and Reconstructive Surgery: February 2018 - Volume 141 - Issue 2 - p 257–268
doi: 10.1097/PRS.0000000000004072
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Background: The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors’ group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced.

Methods: A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site.

Results: A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent.

Conclusions: The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors’ second choice after the deep inferior epigastric artery perforator flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Maastricht, The Netherlands; Temple, Texas; New York, N.Y.; and New Orleans, La.

From the Departments of Plastic, Reconstructive, and Hand Surgery, Anatomy and Embryology, Radiology, GROW – School for Oncology and Developmental Biology, and NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center; the Division of Plastic Surgery, Baylor Scott & White Health; the Department of Plastic Surgery, New York University Langone Medical Center; and the Division of Plastic Surgery, Louisiana State University Health Sciences Center.

Received for publication April 20, 2017; accepted August 25, 2017.

This trial is registered under the name “Lateral Thigh Perforator (LTP) Flap for Autologous Breast Reconstruction,” ClinicalTrials.gov registration number NCT03106233 (https://clinicaltrials.gov/ct2/show/NCT03106233).

Presented at the Annual Meeting of the American Society for Reconstructive Microsurgery, in Waikoloa, Hawaii, January 14 through 17, 2017; and in part at the 27th Annual Meeting of the European Association of Plastic Surgeons, in Brussels, Belgium, May 26 through 28, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work.

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Stefania M. H. Tuinder, M.D., Ph.D., Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands, s.tuinder@mumc.nl

©2018American Society of Plastic Surgeons