Septocutaneous Tensor Fasciae Latae (sc-TFL) perforator flap for breast reconstruction: Radiological considerations and clinical series ABSTRACT Introduction The deep inferior epigastric artery perforator (DIEP) flap is the first choice in autologous breast reconstruction. However, in case the DIEP can not be used, alternative flaps should be available. A radiological study and clinical cases of the sc-TFL flap for breast reconstruction are presented. Materials MRA’s of fifty-five patients scheduled for autologous breast recon- struction were evaluated. The pedicle and the perforators of the TFL were studied. Number of septocutaneous branches of the ascending branch of the lateral circumflex femoral artery (LCFA), origin of the LCFA, location of the septocutaneous branches and maximal pedicle length were analyzed. Five consecutive sc-TFL flaps for breast reconstruction were performed in four patients. Demographics, perforator characteristics, operative technique and time, length of hospital stay and outcomes were registered. Results From the 55 analyzed MRA scans 37 were included. A total of 109 septocutaneous perforators were found and evaluated (mean; 1,5 sc-per- forators/thigh). The mean pedicle length was 8,3 cm. Every perforator originated from a branch of the LCFA. The LCFA originated in 10.8% of cases from the arteria femoralis communis and in 89.2% of cases from the arteria femoralis profunda. In a vertical plane the mean distance of the per- forator from the antero-superior iliac spine was 8,7 cm. There were no major complications in the five sc-TFL performed. Conclusion On MRA the septocutaneous-pedicle of the TFL perforator flap is present consistently. The dissection of the sc-TFL seems to be relatively straight forward. The procedure can be performed in a prone position simultaneous- ly with the mastectomy en/or dissection of the mammary vessels. Finally, the donor site scar can be hidden under the underwear and gives minimal deformity. We recommend the sc-TFL flap as a good alternative to the DIEP flap for autologous breast reconstruction. Preopertive imaging is mandatory for a correct planning of the flap. 132
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