Article

Discussion of 'Transverse thoracodorsal artery perforator flaps: experience with 31 free flaps'

Tulane Health Sciences Center, Division of Plastic and Reconstructive Surgery, 1430 Tulane Avenue, SL-22, New Orleans, LA 70112, USA.
Journal of Plastic Reconstructive & Aesthetic Surgery (Impact Factor: 1.47). 02/2008; 61(4):380-1. DOI: 10.1016/j.bjps.2007.10.051
Source: PubMed
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    ABSTRACT: The thoracodorsal artery perforator flap is a relatively new flap that has yet to find its niche in reconstructive surgery. At the authors' institution it has been used for limb salvage, head and neck reconstruction, and trunk reconstruction in cases related to trauma, burns, and malignancy. The authors have found the flap to be advantageous for cranial base reconstruction and for resurfacing the face and oral cavity. The flap has been used successfully for reconstruction of traumatic upper and lower extremity defects, and it can be used as a pedicled flap or as a free tissue transfer. The perforating branches of the thoracodorsal artery offer a robust blood supply to a skin-soft-tissue paddle of 10 to 12 cm x 25 cm, overlying the latissimus dorsi muscle. The average pedicle length is 20 cm (range, 16 to 23 cm), which allows for a safe anastomosis outside the zone of injury in traumatized extremities; the flap can be made sensate by neurorrhaphy with sensory branches of the intercostal nerves. Vascularized bone can be transferred with this flap by taking advantage of the inherent vascular anatomy of the subscapular artery. A total of 30 pedicled and free flap transfers were performed at the authors' institution with an overall complication rate of 23 percent and an overall flap survival rate of 97 percent. Major complications, such as vascular thrombosis, return to the operating room, fistula formation, recurrence of tumor, and flap loss, occurred in 17 percent of the patients. Despite these drawbacks, the authors have found the thoracodorsal artery perforator flap to be a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction cases.
    Plastic &amp Reconstructive Surgery 08/2004; 114(1):32-41; discussion 42-3. DOI:10.1097/01.PRS.0000129071.03842.C5 · 3.33 Impact Factor
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    ABSTRACT: The conventional design of free thoracodorsal artery perforator (TDAP) flaps is orientated vertically along the long axis of the latissimus dorsi muscle, i.e. along the course of the descending branch of the thoracodorsal artery. However, this method does not consider perforators derived from the transverse branch of the thoracodorsal artery, and leaves a long scar that runs perpendicular to the relaxed skin tension line. Accordingly, scar widening and hypertrophy are frequently encountered problems. From April 2004 to December 2005, 31 free TDAP flap transfers were performed in 29 patients for reconstruction of the lower extremity (16 flaps), head and neck (12 flaps), and upper extremity (three flaps). Flap long axes were laid transversely following the relaxed skin tension line and paddles were designed to include proximal perforators from both branches of the thoracodorsal artery. Flap sizes ranged from 7x5 cm to 22x12 cm with a mean thickness of 7.5mm (range 3-13 mm). Among the 40 perforators employed as pedicles, 34 were derived from the descending branch and six were from the transverse branch of the thoracodorsal artery. Except for a single case of total flap loss, the other flaps were successfully transferred. Donor scars ranged from 6 to 28 mm in width after a minimum follow-up period of 10 months. The transverse design may be preferred whilst planning free TDAP flap transfer, because the surgeon has a wider choice of perforators and the final donor scar has a less disfiguring appearance.
    Journal of Plastic Reconstructive & Aesthetic Surgery 02/2008; 61(4):372-9. DOI:10.1016/j.bjps.2007.10.050 · 1.47 Impact Factor
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    ABSTRACT: The possibility of raising the cutaneous island of the latissimus dorsi musculocutaneous flap without muscle based on only one cutaneous perforator is presented in this paper. An anatomic study performed in 40 fresh cadaver specimens injected with colored latex demonstrated that the vertical intramuscular branch of the thoracodorsal artery gives off two to three cutaneous branches (perforators) that are consistently present. The largest one, measuring approximately 0.4 to 0.6 mm in diameter, provides the blood supply to a 25 x 15 cm cutaneous island. The incorporation of the proximal trunk of the thoracodorsal artery lengthens the pedicle, facilitating the anastomosis or the arc of rotation (in the case of island flaps) but does not increase the amount of tissue transferable. Five clinical cases were done with this technique without tissue necrosis or flap loss.
    Plastic &amp Reconstructive Surgery 01/1996; 96(7):1608-14. DOI:10.1097/00006534-199512000-00014 · 3.33 Impact Factor