The vascular basis of the thoracodorsal artery perforator flap.
ABSTRACT Musculocutaneous perforator flaps, or more simply, perforator flaps, have become increasingly popular in microsurgery because of numerous advantages, including reduced donor-site morbidity. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels. The objective of this study was to document the vascular anatomy of this flap in human cadaveric studies.
The anatomy of the perforators of the thoracodorsal artery was studied using a modified lead oxide-gelatin injection technique in 15 fresh human cadavers. Each fresh cadaver was injected with lead oxide, gelatin, and water, and then cooled to 4 degrees C for 24 hours before dissection. The torso was dissected to identify all cutaneous perforators in the region of the back and flank.
The mean area of the primary and secondary zones supplied by the thoracodorsal artery was 255 cm2 and 345 cm2, respectively. The mean length of the major and minor axes was 18 cm and 13 cm, respectively. The maximum dimensions of the skin that could potentially be supplied by the thoracodorsal artery averaged 600 cm2, with a major axis length of 28 cm and a minor axis length of 27 cm. A mean number of 5.5 perforators with a mean diameter of 0.9 mm (range, 0.5 to 1.5 mm) supplied this zone. The ratio of musculocutaneous to septocutaneous perforators from the thoracodorsal artery was 3:2. The length of the thoracodorsal pedicle when harvested along with the perforator was 14.0 cm, with the vessel diameter being 2.8 mm at the origin. The most proximal perforator was seen at the level of the inferior angle of the scapula, 3.0 cm medial to the anterior border of the muscle. The intramuscular course of the perforators averaged 5 cm (range, 3 to 7 cm). Septocutaneous perforators from the thoracodorsal artery supplying the skin in addition to the musculocutaneous perforators were seen in 60 percent of specimens.
The thoracodorsal artery perforator flap is a reliable cutaneous perforator flap that is very useful in a wide variety of clinical applications.
- SourceAvailable from: scirp.org[Show abstract] [Hide abstract]
ABSTRACT: Background/Aims: In this study, the different types of arterial diameter measurement methods were com-pared with each other on rat model. Methods: The study was planned in three phases. In phase 1, all subjects (n = 30) underwent high resolution B-mode ultrasound examination and external diameter of the right com-mon carotid artery (RCCA) was measured. In phase 2, RCCA was explored. In phase 3, rats were put into three groups. Group 1 was kept at –20˚C, group 2 was embedded in 4% formaldehyde solution. In group 3, circulatory system was filled with %20 latex solution. In all groups, digital image of the RCCA was taken after the processes mentioned above. Images were assessed by Image—Pro Plus software. Results: The greatest average diameter was observed in the high resolution B-mode ultrasound (phase 1). In group 1 and 2, direct measurement of the RCCA on living animal (phase 2) gave significantly wider diameter than those obtained at phase 3 in the same groups. Direct (phase 2) and latex (phase 3) measurements were equal in group 3. Conclusions: High resolution B-mode ultrasound gives larger, probably actual diameter of the artery. Latex injection results might correspond those encountered during operation.Surgical Science. 01/2011; 2:204-208.
- [Show abstract] [Hide abstract]
ABSTRACT: The anatomical topography of the perforators that pierce the latissimus dorsi muscle fascia determines the location and direction of the skin paddle and thus the ultimate design of the thoracodorsal artery perforator flap. The full scope of the thoracodorsal artery perforator topography has not been provided in detail, and the usefulness of perforators from the transverse branch has not been elucidated. While harvesting the thoracodorsal artery perforator flap, every reliable musculocutaneous perforator that derives from the thoracodorsal artery was documented. The number, location, and topographic patterns of the perforators were measured. Twenty-three patients (11 female and 12 male), with a mean age of 34.2 years, were enrolled in this prospective study. A mean number of 4.3 reliable perforators was noted. Of 99 perforators that were documented in 23 latissimus dorsi muscles, 48 were situated along the course of the descending branches of the thoracodorsal artery and 30 were situated along the transverse branches. At least one perforator was found near the lateral muscle border in every muscle, but no reliable perforator was located adjacent to the medial muscle border in four cases. Pedicles of 23 thoracodorsal artery perforator flaps, 24 perforators from the descending branch, and six perforators from the transverse branch were dissected completely. The average intramuscular course of the perforators was 5.3 cm. The topographic results could be used as a reference in the perforator localization for safe and efficient harvesting of the thoracodorsal artery perforator flap.Plastic and reconstructive surgery 03/2008; 121(2):497-504. · 2.74 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Thoracodorsal artery perforator (TAP) flaps without latissimus dorsi muscle - have been used for reconstruction of the extremities, head and neck as free style flaps, and as pedicled flaps for reconstruction of the chest wall and axillary wounds. This retrospective study aimed to analyse the clinical applications and relevant anatomic findings of TAP flaps. METHODS: From April 2007 to August 2011, 67 free or pedicled TAP flaps were transferred in 67 patients for reconstruction of wounds of the extremities, chest wall and axilla. Eight were used as free flaps for reconstruction of extremities, and 59 used as pedicled flaps for reconstruction of axillary or chest wounds. Patient ages ranged from 7 to 55 years (26.04 ± 12.83). Perforator arteries were detected and identified with a hand-held Doppler. The size of flaps ranged from 6 by 9 to 14 by 18 cm ((8.66 ± 2.05) by (12.62 ± 2.03)). Flaps were designed with the perforator artery included, with all flaps based on one or two perforator arteries. RESULTS: All of the flaps survived. There were no problems with vascular spasm or occlusion. Significant venous congestion was not observed in any of the cases. Two cases developed minor wound dehiscence but healed with conservative therapy. None of the donor sites developed seromas. CONCLUSIONS: The thoracodorsal artery flap without associated latissimus dorsi muscle can provide a thin, large and reliable flap with robust blood supply. The TAP flap can significantly reduce donor site morbidity.Journal of Plastic Reconstructive & Aesthetic Surgery 10/2012; · 1.44 Impact Factor