{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:42Z","timestamp":1790585922057,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Extensive lumbosacral defects remain a major reconstructive challenge because of limited regional tissue mobility, contamination risk, proximity to neural structures, and frequent association with prior surgery or spinal instrumentation. Although lumbar artery perforator (LAP) flaps are recognized as muscle\u2010sparing options for posterior trunk reconstruction, their capacity to safely reconstruct very large midline lumbosacral defects and their applicability in rare adult presentations of lumbosacral myelomeningocele remain insufficiently defined. We report two adult female patients who underwent reconstruction of extensive midline lumbosacral defects using bilateral pedicled LAP flaps to illustrate the applicability of this approach in exceptionally large post\u2010instrumentation and adult dysraphic defects. The first patient, a 19\u2010year\u2010old woman, presented with a 36\u2009\u00d7\u200928\u2009cm post\u2010instrumentation defect with exposed L4\u2013S1 hardware following multi\u2010trauma and repeated soft\u2010tissue necrosis. After serial debridements and prolonged culture\u2010directed intravenous antibiotic therapy, bilateral LAP flaps measuring 22\u2009\u00d7\u200912\u2009cm were elevated based on bilateral L4 perforators identified by computed tomography angiography and Doppler ultrasonography. The second patient, a 28\u2010year\u2010old paraplegic woman with spina bifida, presented with recurrent cerebrospinal fluid leakage associated with a 22\u2009\u00d7\u200916\u2009cm lumbosacral myelomeningocele defect. Following neurosurgical dural repair, bilateral LAP flaps measuring 18\u2009\u00d7\u200910\u2009cm were harvested based on medially displaced L4 perforators. In both cases, the flaps were designed according to defect geometry and perforator location, then rotated approximately 90\u00b0 medially to achieve tension\u2010reduced midline closure while facilitating primary donor\u2010site closure. Complete flap survival was achieved in both patients without venous congestion or total flap loss. In the first case, limited wound dehiscence related to hardware prominence was successfully revised with a local V\u2013Y advancement flap, and a small donor\u2010site tension area was managed with split\u2010thickness skin grafting. In the second case, a limited lateral donor defect also required split\u2010thickness skin graft coverage. At 13\u2009months, spinal instrumentation was electively removed in the first patient after adequate osseous stabilization, while flap stability was preserved. At 15 and 9\u2009months of follow\u2010up, respectively, both patients demonstrated durable soft\u2010tissue coverage without recurrent breakdown or cerebrospinal fluid leakage. These cases suggest that bilateral pedicled LAP flaps may facilitate stable, muscle\u2010sparing reconstruction in selected extensive lumbosacral defects, including exceptionally large post\u2010instrumentation wounds and rare adult presentations of lumbosacral myelomeningocele.<\/jats:p>","DOI":"10.1002\/micr.70293","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:12:01Z","timestamp":1789035121000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Lumbar Artery Perforator (\n                    <scp>LAP<\/scp>\n                    ) Flaps for Extensive Lumbosacral Defects: A Report of Two Cases"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6230-9387","authenticated-orcid":false,"given":"Serdar","family":"D\u00f6nmez","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1862-771X","authenticated-orcid":false,"given":"Furkan Altar","family":"Deniz","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3741-2445","authenticated-orcid":false,"given":"Muhammed","family":"Karakaya","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4667-1550","authenticated-orcid":false,"given":"Menek\u015fe Kastamoni","family":"Ba\u015fkan","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2430-727X","authenticated-orcid":false,"given":"S\u00fcleyman","family":"\u00c7e\u00e7en","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fczin Ye\u015fim","family":"\u00d6zgenel","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sel\u00e7uk","family":"Ak\u0131n","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery Bursa Uluda\u011f University Faculty of Medicine  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.5.SPINE08962"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381\u2010020\u201004796\u2010z"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000646"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.25259\/SNI_11_2025"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31826caf5a"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002089"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2002.3791"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010200205000\u201000028"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/23320885.2016.1147330"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100031\u20101275492"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpra.2025.10.005"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.07.463"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.1999.3120"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010198804000\u201000012"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534\u2010199101000\u201000018"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181904b24"},{"key":"e_1_2_9_18_1","volume-title":"Pediatric Plastic Surgery","author":"Oakes W. 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