The Vascular Basis of the Thoracodorsal Artery Perforator Flap

Department of Anatomy and Neurobiology and Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 10/2005; 116(3):818-22. DOI: 10.1097/01.prs.0000176253.42394.7c
Source: PubMed


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.

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    • "Kim et al. reported the use of thin latissimus dorsi perforator flaps including only the superficial adipose layer.[12] Binu et al. reported the cutaneous vascular supply of the thoracodorsal artery and and the number and type of perforators by means of human cadaver dissection.[1314] "
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    ABSTRACT: The thoracodorsal artery perforator (TDAP) flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years). The mean follow-up period was 8 months (range, 4-22 months). All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.
    No preview · Article · Sep 2012 · Indian Journal of Plastic Surgery
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    • "The length of the pedicle, an average of 15 cm [3] [8], is comparable to that of the radial forearm flap. A long pedicle constitutes an advantage, particularly in cancer surgery, in which the number of available recipient neck vessels is often very limited. "

    Full-text · Article · Apr 2012 · European Annals of Otorhinolaryngology, Head and Neck Diseases
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    • "They may be indirect as in the radiological methods such as MR [7], CT [8] or ultrasound [9] [10], or direct, using digital or manual calipers [11] during operation. In a cadaver, the arterial diameter can be either measured directly [12] [13] or after filling the arterial system with either of silicone [14], latex [15] [16], or oxide-gelatin [15] [17]. 0.08 SD; p = 0.001), respectively. "
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    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.
    Preview · Article · Jan 2011 · Surgical Science
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