Thoracodorsal Artery Perforator Flap: A Versatile Alternative for Various Soft Tissue Defects

Suhan Ayhan; Serhan Tuncer; Yucel Demir; Sebahattin Kandal

doi:10.1055/s-2008-1080539

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2008; 24(4): 285-293
DOI: 10.1055/s-2008-1080539

Thoracodorsal Artery Perforator Flap: A Versatile Alternative for Various Soft Tissue Defects

Suhan Ayhan¹ , Serhan Tuncer¹ , Yucel Demir¹ , Sebahattin Kandal¹

¹Plastic, Reconstructive, and Aesthetic Surgery Department, Gazi University Faculty of Medicine, Ankara, Turkey

Abstract

ABSTRACT

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.

KEYWORDS

Thoracodorsal artery perforator flap - perforator flap - TDAP - versatile flap - soft tissue reconstruction - pedicled TDAP flap

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Referenzen

REFERENCES

1 Fodor P B, Khoury F. Latissimus dorsi muscle flap in reconstruction of congenitally absent breast and pectoralis muscle. Ann Plast Surg. 1980; 4 422-425
2 Lassen M, Krag C, Nielsen I M. The latissimus dorsi flap: an overview. Scand J Plast Reconstr Surg. 1985; 19 41-51
3 Russell R C, Pribaz J, Zook E G et al.. Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg. 1986; 78 336-344
4 Titley O G, Spyrou G E, Fatah M F. Preventing seroma in the latissimus dorsi flap donor site. Br J Plast Surg. 1997; 50 106-108
5 Blondeel P N, Van Landuyt K HI, Monstery S JM et al.. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003; 112 1378-1383
6 Taylor G I, Palmer J H. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987; 40 113-141
7 Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995; 96 1608-1614
8 Van Landuyt K, Hamdi M. Thoracodorsal artery perforator flap. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC Perforator Flaps: Anatomy, Technique, and Clinical Applications. St. Louis, MO; QMP Medical Publishing 2006: 441-459
9 Thomas B P, Geddes C R, Tang M et al.. The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg. 2005; 116 818-822
10 Guerra A B, Metzinger S E, Lund K M et al.. The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg. 2004; 114 32-41
11 Heitmann C, Guerra A, Metzinger S W et al.. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg. 2003; 51 23-29
12 Schwabegger A H, Bodner G, Ninkovic M, Piza-Katzer H. Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature. Br J Plast Surg. 2002; 55 390-395
13 Kim D Y, Cho S Y, Kim K S et al.. Correction of axillary burn scar contracture with the thoracodorsal perforator-based cutaneous island flap. Ann Plast Surg. 2000; 44 181-187
14 Schwabegger A H, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg. 2003; 111 1407-1411
15 Geddes C R, Morris S F, Neligan P C. Perforator flaps: evolution, classification, and applications. Ann Plast Surg. 2003; 50 90-99
16 Lin C-T, Huang J-S, Yang K-C et al.. Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap. Plast Reconstr Surg. 2006; 118 1376-1386
17 Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg. 2004; 57 531-539
18 Kim J T, Koo B S, Kim S K. The thin latissimus dorsi perforator-based free flap for resurfacing. Plast Reconstr Surg. 2001; 107 374-382
19 Kim J T, Kim S K. Hand resurfacing with the superthin latissimus dorsi perforator-based free flap. Plast Reconstr Surg. 2003; 111 366-370
20 Koshima I, Saisho H, Kawada S et al.. Flow-through thin latissimus dorsi perforator flap for repair of soft-tissue defects in the legs. Plast Reconstr Surg. 1999; 103 1483-1490
21 Van Landuyt K, Hamdi M, Blondeel P, Monstrey S. The compound thoracodorsal perforator flap in the treatment of combined soft-tissue defects of sole and dorsum of the foot. Br J Plast Surg. 2005; 58 371-378
22 Kim S E, Rhyou I H, Suh B G, Chung K C. Use of thoracodorsal artery perforator flap for soft tissue reconstruction in children. Ann Plast Surg. 2006; 56 451-454
23 Koshima I, Soeda S. Inferior epigastric artery skin flap without rectus abdominis muscle. Br J Plast Surg. 1989; 42 645-648
24 Wei F C, Çelik N. Perforator flap entity. Clin Plast Surg. 2003; 30 325-329
25 Spinelli H M, Fink J A, Muzaffar A R. The latissimus dorsi perforator-based fasciocutaneous flap. Ann Plast Surg. 1996; 37 500-506
26 Kim J-T. Latissimus dorsi perforator flap. Clin Plast Surg. 2003; 30 403-431
27 Soldin M G, Tulley P, Kaplan H et al.. Chronic axillary hidradenitis: the efficacy of wide excision and flap coverage. Br J Plast Surg. 2000; 53 434-436
28 Amarante J, Reis J, Comba A S et al.. A new approach in axillary hidradenitis treatment: the scapular island flap. Aesthetic Plast Surg. 1996; 20 443-446
29 Rehman N, Kannan R Y, Hassan S et al.. Thoracodorsal artery perforator (TAP) type I V–Y advancement flap in axillary hidradenitis suppurativa. Br J Plast Surg. 2005; 58 441-444
30 Sarıguney Y, Ayhan S, Tuncer S et al.. Reconstruction of the postburn breast deformity using thoracodorsal artery perforator flap. Turk J Plast Reconstr Aesthet Surg. 2006; 14 18-22
31 Hallock G G. Doppler sonography and color duplex imaging for planning a perforator flap. Clin Plast Surg. 2003; 30 347-357
32 Masia J, Clavero J A, Larranaga J R et al.. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg. 2006; 59 594-599
33 Wei F C, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004; 114 910-916
34 Bidros R S, Metzinger S-E, Guerra A B. The thoracodorsal artery perforator-scapular osteocutaneous (TDAP-SOC) flap for reconstruction of palatal and maxillary defects. Ann Plast Surg. 2005; 54 59-65
35 dos Santos L F. The vascular anatomy and dissection of the free scapular flap. Plast Reconstr Surg. 1984; 73 599-604
36 Maruyama Y. Ascending scapular flap and its use for the treatment of axillary burn scar contracture. Br J Plast Surg. 1991; 44 97-101
37 Momeni A, Krischak S, Bannasch H. The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect. Microsurgery. 2006; 26 515-518

Serhan TuncerM.D.

42 Cadde 451, Sokak No. 8/5

Cukurambar, Ankara, Turkey