Septocutaneous tensor fasciae latae perforator flap for breast reconstruction: Radiological considerations and clinical cases

INTRODUCTION: The deep inferior epigastric artery perforator (DIEP) flap is the first choice in autologous breast reconstruction; in cases when it cannot be used, alternative flaps are available. A radiological study and clinical cases using septocutaneous tensor fasciae latae (sc-TFL) flap for breast reconstruction are presented. MATERIALS: Magnetic resonance angiographies (MRAs) of 55 patients were evaluated. The pedicle and the perforators of the TFL were studied. Five consecutive sc-TFL flaps for breast reconstruction were performed. RESULTS: Thirty-seven MRA scans were included. There was a mean of 1.5 septocutaneous perforators per thigh. The mean pedicle length was 8.3 cm. Every perforator originated from a branch of the lateral circumflex femoral artery (LCFA). The LCFA originated from the arteria femoralis profunda in 89.2% of cases. In the vertical plane, the mean distance of the perforator 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 was consistently present. MR angiographic assessment of the septocutaneous branches was very helpful in the preoperative evaluation of our patients. Dissection of the sc-TFL can be performed in a supine position simultaneously with mastectomy and/or dissection of the mammary vessels. Finally, the donor-site scar can be hidden by underwear, giving minimal deformity. We recommend the sc-TFL flap as a good alternative to the DIEP flap for autologous breast reconstruction. Preoperative imaging is mandatory for correct planning of the flap.