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Septocutaneous Tensor Fasciae Latae (sc-TFL) perforator flap for breast reconstruction: Radiological considerations and clinical series clinical series of 4 patients where the flap was used to cover soft tissue defects after a work injury. Also in this paper the positioning of the flap was along the long axis of the TFL muscle. It is important to realize that the TFL muscle has a ventral and a dorsal septum. The ventral septum is the space between the TFL muscle and the rectus-vastus lateralis muscles. The dorsal septum is the space between the TFL and the gluteus medius muscles. The pedicle of an sc-TFL flap may run either in the dorsal or ventral septum before converging into the LCFA. Perforators running through the ventral septum have been described by several authors16,17,18. One of our flaps was based on a pedicle with the course mentioned above. A pedicle running through the ventral septum is easier to dissect because it is easier to retract the muscles and expose the vessels but the pedicle is shorter. The preoperative marking of the flap in this case has to be shifted more ventrally . However, we do not recommend the use of the sc-TFL flap for breast reconstruction based on a perforator running in the ventral septum for two reasons. First, in the region of the ventral septum there is less fat volume and second the tension to close the defect will be higher. In our series, the patient with the ventrally based pedicle course, developed a wound dehiscence. The great anatomical variability of the LCFA is well known11,14-15. Our study supports the data of Hubmer et al.11: a septocutaneous perforator running through the dorsal septum and originating from the LCFA is always present. The distance of this perforator/s from the ASIS can be variable. If more than one suitable perforator is present, the one nearest to the ASIS should be chosen: as a consequence the flap will be drawn at the highest position possible to hide the scar by the underwear of the patient. If the septo- cutaneous perforator is far away from the ASIS and the scar will be too low, an sc-GAP will be probably the best option because of the donor scar. The sc-TFL has become the second best-choice donor site for microsurgical breast reconstruction in our institution. Until recently our second best-choice was the sc-GAP flap already described by the author2. The sc-TFL has several advantages compared to the sc-GAP. The patient can remain supine for both flap harvest procedures and inset, which reduces operation time. The pedicle is longer and the veins seem less fragile than in an sc-GAP. The amount of tissue that can be transferred is similar because the region of flap harvesting is nearly the same. During harvesting of the sc-TFL special attention has to be paid avoiding removing too much skin to prevent wound dehiscence. The scar can be hidden in the majority of the cases with low-cut pants and the contour of the hips may even improve through lifting of the saddle-bags. 144


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