The lumbar artery perforator flap: clinical review and guidance on image reporting

Highlights: • The lumbar artery perforator flap provides a durable solution with reliable blood supply to cover large defects regionally or reconstruct distant body structures, such as for breast reconstruction. • Using the flap with the largest diameter of a perforator provides the best results, however, controversy exists about which lumbar perforator is dominant in most patients. • Preoperative vascular imaging with CT or MRI can clearly identify the dominant perforator as well as, number of perforators, their course, and the location of lumbar fascia perforation. -- Abstract: The lumbar artery perforator (LAP) flap is a relatively new procedure that can be utilized to manage lumbosacral defects in addition to reconstructing distal body parts as well, such as breast reconstruction. This fasciocutaneous flap is designed based on the LAPs small arteries that emerge from the lumbar arteries then move superficially piercing overlying tissues to perforate the lumbar fascia and supply the skin and subcutaneous tissue; However, anatomical and clinical studies regarding the LAP flap and its perforators are sparse in the literature, and the results are even contradicting. This article will discuss the LAP flap, the anatomy of its perforators, and the clinical aspects about its usage. In addition, we explore its preoperative imaging evaluation, and deliver a guide on image reporting and radiological data that will benefit the surgeon most during the procedure.