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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Mathis DW, Thornton JF, Rohrich RJ (2006) Management of posterior trunk defects. Plast Reconstr Surg 118:73e–83e
Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD (2003) Muscle flap salvage of spine wounds with soft tissue defects or infection. Spine 28:1203–1211
Wilhelmi BJ, Snyder N, Colquhoun T et al (2000) Bipedicle paraspinous muscle flaps for spinal wound closure. Plast Reconstr Surg 106:1305–1311
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 118:1338–1348
O’Shaughnessy BA, Dumanian GA, Liu JC, Ganju A, Ondra SL (2007) Pedicled omental flaps as an adjunct in complex spine surgery. Spine 32:3074–3080
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 56:526–530
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 114:1864–1868
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 71:394–401
Mathur BS, Tan SS, Bhat FA, Rozen WM (2016) The transverse lumbar perforator flap: an anatomic and clinical study. J Plast Reconstr Aesthet Surg 69:770–776
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 77:332–336
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 61:917–924
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 138:343–352
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 77:469–476
McGregor IA, Jackson IT (1972) The groin flap. Br J Plast Surg 25:3–16
Akyurek M, Conejero A, Dunn R (2008) Deep circumflex iliac artery perforator flap without iliac crest. Plast Reconstr Surg 122:1790–1795
Teo TC (2010) The propeller flap concept. Clin Plast Surg 37:615–626
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 64:745–759
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 100:1703–1709
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 64:595–604
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Electronic supplementary material
DCIA perforator skin flap rotation to lower back defect based on propeller flap design. (MOV 6546 kb)
Rights and permissions
About this article
Cite this article
Akyurek, M., Albert, M. Deep circumflex iliac artery perforator flap: a new option for reconstruction of lumbosacral defects. Eur J Plast Surg 42, 201–204 (2019). https://doi.org/10.1007/s00238-018-1461-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-018-1461-9