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Fisher et al. Plast Aesthet Res 2024;11:36 https://dx.doi.org/10.20517/2347-9264.2024.53 Page 9 of 13

Figure 6. LAP flap elevation and harvest. LAP: Lumbar artery perforator.

Figure 7. Perforator dissection.

If, during the course of elevation of the undersurface of the flap, a sensory cluneal nerve is observed to enter
the underside of the flap, the nerve can be incorporated into the flap for the option of neurotization
[Figure 7]. Other than a sensory nerve that enters the undersurface of the flap, cluneal nerves that are
encountered during flap elevation should be preserved. Division of cluneal nerves can contribute to donor
[27]
site numbness and paresthesia . If large sensory nerves that are not incorporated into the flap must be
divided, consideration should be given to primary nerve repair.