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The authors of this paper present the first meaningful series utilising the lateral thigh perforator flap for breast construction. Eight patients had delayed unilateral reconstruction, each with two stacked flaps. Anastamoses were performed antegrade and retrograde to one internal mammary pedicle. They report 100% flap success, the commonest postoperative complications were limited to donor-site seroma and wound dehiscence. The authors highlight the ease of harvest, due to reliable anatomy and patient positioning, as major advantages over other reconstructive options in patients in whom an abdominal free flap is contraindicated. Anatomically, the flap is based on consistent and reliable septocutaneous perforators arising from the ascending branch of the lateral circumflex artery. A flap size of 20-26 x 8-9cm can be closed primarily with an average pedicle length of 10cm, a flap weight ranging from 233 to 624grams and given the location, three teams can work simultaneously to reduce overall operative time. These factors, together with the anecdotal increase in patients with insufficient abdominal tissue, make this flap another useful option for the microvascular breast reconstruction. This paper would benefit from a more detailed description of flap harvest but overall provides useful information that could easily be translated into standard clinical practice.

Stacked lateral thigh perforator flap as a novel option for autologous breast reconstruction.
Tessler O, Guste J, Bartow M, et al.
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James ET Wokes

University Hospital North Durham, UK

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