Free Thoracodorsal Artery Perforator Flap for Head and Neck Reconstruction: An Indian Experience

Abstract

Background We describe our experience with use of free thoracodorsal artery perforator (TDAP) flap for head and neck (H&N) cancer reconstruction, with respect to the patient and disease profile, suitable defect characteristics, the reconstructive technique, and complications.

Methods Consecutive patients (N = 26) undergoing free TDAP flap for H&N onco-reconstruction, in a single center, were included from January 2015 to December 2018 and the data were analyzed.

Results Perforator(s) were reliably predicted preoperatively, using handheld Doppler. Lateral position was comfortable for the harvest. Twenty flaps were harvested on a single perforator, more commonly musculocutaneous (n = 16). The thoracodorsal nerve and latissimus dorsi muscle could be preserved, completely in almost all cases. The skin paddle was horizontally (n = 5) or vertically (n = 21) oriented, both giving a satisfactory scar. The flap was used as a single island or two islands by de-epithelializing intervening skin. Pedicle length was sufficient in all cases. Four cases were explored for suspected venous insufficiency. Two had thrombosis, of which one was salvaged, while the other necrosed. One flap had minimal partial necrosis, which was managed with secondary suturing. The 5-year follow-up showed good oral competence, mouth opening, and cosmetic satisfaction among patients.

Conclusion TDAP flap provides all the advantages of a perforator-based free flap and of back as a donor site with close color match to the face, relatively hairless, and thickness in between the thigh and the forearm. It can be a useful tool to provide an ideal functional and aesthetic outcome, with a hidden donor site and minimal donor site morbidity in selected cases.

Keywords

thoracodorsal artery perforator flap - TDAP flap - TAP flap - head and neck reconstruction - perforator free flap - head and neck cancer

Author Contributions

D.J. and V.K.S. performed the surgeries. M.M. and S.M. assisted in the surgeries. A.B. and V.K. followed up the patients. S.J. and D.J. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. They also wrote the manuscript. P.Y. and A.B. reviewed the manuscript.

Declaration of Helsinki

The study was done in adherence to the Declaration of Helsinki protocol. Proper preprocedure consents were taken for surgery, documentation, and research purposes. The study was approved by the Institutional Ethics Committee. Data storage was performed consistent with the good clinical practice guidelines.

Publikationsverlauf

Artikel online veröffentlicht:
03. November 2023

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