PURPOSE:  Pedicled perforator flaps, incorporate the advantages of reduced donor site morbidity, allow the replacement of like with like, and avoid the risks associated with microvascular anastomosis. The thoracic and lumbar regions are dense in perforator concentration and provide a large potential for pedicle perforator flap designs.

METHOD: A total of ten fresh cadaver hemi-backs were used and all perforators ≥ .5mm were dissected in both the thoracic and lumbar regions. Perforator location was measured relative to C7 and the midline for thoracic perforators and relative to the coccyx and midline for the lumbar perforators. The perforators were cannulated and injected with Omnipaque contrast using a Harvard precision pump at 0.5ml/minute, and the flap subjected to dynamic CT scanning using a GE Lightspeed sixteen slice scanner. Images were viewed using both General Electric and TeraRecon systems, allowing analysis of perfusion flow, as well as measurements of vascular territory and direction of flow.

RESULTS: A total of 393 perforators were dissected from both the thoracic and lumbar regions. The average number of perforators in the thoracic region was 17.8; median 15.5, mode: 15, whereas the average number of perforators in the lumbar region was 21.5; median 21.5, mode: 21. Direction of flow is dependent on perforator location either centrally or peripherally. The lumbar perforators were the largest encountered.

CONCLUSION: This study provides the basis of pedicled perforator flaps from the thoracic and lumbar regions for reconstruction of midline and lateral defects of the back.