Plastic and Reconstructive Surgery: June 2019 - Volume
143 - Issue 6 - p 1601–1604
by Tessler, Oren; Guste, John; Bartow, Matthew J.; Torabi,
Radbeh; Gimenez, Alejandro; Patel, Shukan B.; Matatov, Tim; Torabi, Rozbeh; St.
Hilaire, Hugo; Allen, Bob
Background:
Autologous breast reconstruction using perforator flaps offers excellent
outcomes, minimizes donor-site morbidity, and allows for precise donor-site
selection. The deep inferior epigastric artery perforator, profunda artery
perforator, and gluteal artery perforator flaps along with the stacked flap
technique are the most common options. This study reports the first series of
the stacked lateral thigh perforator flap.
Methods: A
retrospective review of all stacked lateral thigh perforator flaps done by a
single group of surgeons was performed. Demographics, flap weights,
complications, indications, and surgical technique were tabulated for each
patient.
Results: Eight
female patients with a history of breast cancer underwent delayed unilateral
breast reconstruction with stacked lateral thigh perforator flaps for a total
of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap
weight were 47.3 years, 26.2 kg/m2, 333.1 g, and 666.1 g, respectively.
Microsurgical revascularization was completed in anterograde and retrograde
fashion to the internal mammary vasculature. Flap survival was 100 percent and
one subsequent flap revision was performed. Two patients developed a seroma at
the donor site. Indications included insufficient abdominal tissue, prominent
lateral thigh lipodystrophy, prior abdominal surgery, and failed prior
abdominally based autologous reconstruction.
Conclusions: This
series demonstrates that the lateral thigh perforator flap is a reliable and
effective option for a stacked breast reconstruction. Its ease of harvest
(stemming from reliable anatomy), straightforward dissection, and
intraoperative positioning make it an appealing flap option. The stacked
lateral thigh perforator flap allows the reconstructive surgeon to tailor
breast reconstruction to the patient, focusing on body habitus and minimizing
morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
