Chapter 8 INTRODUCTION The deep inferior epigastric artery perforator flap (DIEP) is accepted worldwide as the first choice in autologous breast reconstruction. However, in patients with previous abdominoplasty, lack of sufficient subcutaneous fat or scarring in the abdominal region, breast reconstruction with DIEP flap may not be possible. The most common alternatives to the DIEP flap in these patients the transverse myocutaneous gracilis (TMG) flap1 and the superior gluteal artery perforator (S-GAP) flap2, which use respectively the inner thigh or the gluteal region as donor-site. The lateral thigh region as a tissue source for breast reconstruction has been described in 1990 by Elliot3 (as a tensor fasciae latae (TFL) myocuta- neous free flap) and later in 2011 by Kind et al.4 (as a case report with a TFL perforator flap). In both studies no preoperative imaging was performed. This is most probably the reason why at one of the TFL perforator flaps failed in the article described by Kind. The effect on the donor morbidity of the TFL is not described in literature. We hypothesized that the upper lateral thigh region might be very attractive as a donor site. In this paper we focused on the best way to harvest a free flap from the upper lateral thigh region. In preoperative MRA’s of patients scheduled for a breast reconstruction with DIEP flap we observed the constant presence of septocutaneous perforators running between the TFL and the gluteus me- dius muscles vascularizing both the upper lateral thigh region, the gluteal region and the TFL muscle. Based on this observation, we retrospectively analyzed all MRA examinations with specific focus on the lateral thigh region. In addition a literature review on the TFL and TFL perforator flaps was performed. Using this information we decided to perform a septocutaneous TFL (sc-TFL) free perforator flap for breast reconstruction in 4 patients. PATIENTS AND METHODS Patients who underwent a breast reconstruction with a DIEP flap between January and December 2012 were included in this study. A total of 55 MRA examinations were available for retrospective analysis. In the second stage of this study, 5 breast reconstructions in 4 patients were performed using a septocutaneous TFL flap. 133
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