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.
Article: Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients.[show abstract] [hide abstract]
ABSTRACT: The thoracodorsal artery perforator flap is considered a technically difficult flap because of significant anatomical variations in perforator location. The authors' strategy to facilitate the harvest of these flaps includes careful preoperative mapping of perforators and a standardized planning and harvesting technique. The authors evaluated 99 pedicled thoracodorsal artery perforator flaps, with an emphasis on preoperative planning, surgical technique, and analysis of complications. Between May of 2000 and October of 2006, 99 patients underwent pedicled thoracodorsal artery perforator flaps in the authors' department. Their charts and postoperative results were reviewed retrospectively. A thoracodorsal artery perforator flap was harvested in 90 cases. The perforators were unsuitable in the other 10 flaps; therefore, a muscle-sparing technique was used (type I or type II). Unidirectional Doppler imaging was used exclusively in 92 percent of cases to map the perforator preoperatively. The average flap size was 20 x 8 cm. Average operative time for flap harvest was 80 minutes. Perforators were located at 8 to 13 cm from the axillary crease (average, 10.8 cm). Major flap necrosis occurred in one case (1 percent). Limited partial or palpable fat necrosis occurred in three cases (3 percent). Seroma formation was not encountered in any of the thoracodorsal artery perforator flaps or muscle-sparing thoracodorsal artery perforator type I flaps. Careful preoperative perforator mapping and a standardized approach to flap planning and harvest can significantly reduce the difficulty of executing pedicled thoracodorsal artery perforator flaps.Plastic and reconstructive surgery 06/2008; 121(5):1632-41. · 2.74 Impact Factor
Article: Anatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery (SCIP Flap): a cadaveric study.[show abstract] [hide abstract]
ABSTRACT: The groin flap, based on the superficial circumflex iliac artery, was the first successful free flap. However, its popularity was lost essentially due to variable arterial anatomy. Clinical applications of perforator flap based on superficial circumflex iliac artery suggest that a dominant perforator based on his deep branch is enough to supply a large groin flap. Fresh cadaveric dissections were performed and the perforators of Sartorius based on the deep branch of superficial circumflex iliac artery were identified. The dominant perforator was isolated and injected selectively with methylene blue solution. We performed 20 dissections of superficial circumflex iliac artery and the deep branch. We found a deep branch with 2 perforators penetrating the Sartorius muscle. The diameter of the dominant perforator of the deep branch was 0.85 mm on average and the mean injected skin area was 162 cm(2). These findings are in agreement with early clinical suggestion. The dominant musculocutaneous perforator of the deep branch of superficial circumflex iliac artery provides constant and reliable blood supply to ensure a relatively large perforator groin flap.Eplasty 01/2010; 10:e11.
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ABSTRACT: To systematically determine the location and number of cutaneous perforators greater than 0. 5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap for resurfacing shallow defect. Sixty dissections of the thoracodorsal arterial system were carried out in 30 preserved cadavers. The location and number of cutaneous perforators greater than 0.5 mm in diameter of the lateral branch of the thoracodorsal artery perforator flap were studied and measured. Seventy-six perforators were found in 60 flaps (1.3 perforators per flap). The first perforator was exited in all dissections. It emerged from the latissimus dorsi muscle 9.8 cm below the dome of the axilla. In 21.67% of the cases, the second perforator of the thoracodorsal artery arose 3.4 cm distal to the origin of the first perforator The third perforator was found in 5% of dissections, and originated 3.0 cm away from the origin of the second perforator In addition, most perforators penetrated the muscle within 7.0-14. 0 cm below the dome of the axilla. The center of the flap designed should be placed between 7 to 14 cm from the dome of the axilla.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 06/2007; 90(5):947-55.