The tdap flap technique is suited for specialized patients. The tap flap is an alternative to the more established muscular latissimus dorsi ld flap 2,3. Extended thoracodorsal artery perforator flap for breast. Dissection is performed from distal to proximal in order to identify the musculocutaneous perforator. In this article, we present the results of the use of thoracodorsal artery perforator tdap chimeric flaps including a latissimus dorsi ld or serratus anterior sa muscle to prevent pedicle compression for lower extremity. Velopharyngeal function after free thoracodorsal artery.
Composite osteomyocutaneous flap are used for face and neck reconstruction, but less commonly in thoracic surgery. Above, left the arc of rotation for the thoracodorsal artery perforator flap. The role of cinematic rendering in preoperative planning. The appearance of the perforator flaps and, specifically, thoracodorsal artery perforator tdap flap, has meant a radical change in relation to lower morbidity of the donor site, thus highly ranking the use of these flaps in the reconstruction for similar defects.
The skin paddle is designed by including the perforator identi. The detailed surgical technique with its variations is explained in this report. The thoracodorsal artery perforator tdap flap is a musclesparing skin and fat flap that requires precise intramuscular dissection of the thoracodorsal artery perforators in the axillary region. Between october 2010 and october 20, 16 cases of lateral malleolus or calcaneus defects were reconstructed using free thoracodorsal artery perforator flaps. The conjoint and separate relations between thoracodorsal artery perforator and intercostal nerve are described, which influence subsequent flap thinning.
Successful correction of postburn mentosternal contracture and kyphosis of thoracic spine with thoracodorsal artery perforator flap. For the axilla, traditional regional flaps that can be used include the scapular flap, the parascapular flap, the circumflex scapular artery propeller flap, the latissimus dorsi muscle flap, and the thoracodorsal artery perforator tap flap. The flap was transposed onto the breast anterolateral and posterolateral chest wall. A thoracodorsal artery perforator chimeric free flap for. Haq eu, javaid rh, hameed s, saood r, majid a, waqas m, aslam a, yusuf o. We investigate the reliable locations of the perforators of the thoracodorsal artery. Clinical application of the thoracodorsal artery perforator flaps. This flap was originally described in 1995 as a method for. Thoracodorsal artery perforator flap as an autologous alternative to. A second perforator that appears to be in the same longitudinal plane as the first can also be dissected free and used to further nourish the flap not pictured. The thoracodorsal artery perforator or tap flap is a fasciocutaneous flap based on a musculocutaneous perforator or perforators from the. Thoracodorsal artery perforator flap for upper limb reconstruction, authors. Modern perforator flap imaging with highresolution blood.
Scapular tipthoracodorsal artery perforator free flap for. This cutaneous branch did not pierce the latissimus muscle but rounded the lateral muscle edge and supplied the overlying subcutaneous tissue and skin. The thoracodorsal artery perforator tap flap has been widely used for breast reconstruction since it was first described by angrigiani et al. Thoracodorsal artery perforator flap as an autologous. The ipsilateral arm is left free and included in the operative scrub. In this study, we present our experience using thoracodorsal or serratus vessels for profunda artery perforator flaps. Although free flap reconstruction, including jejunum and fasciocutaneous flaps. Lower extremity salvage with thoracodorsal artery perforator free flap in condition of symmetrical peripheral gangrene sooyeonlim,1 gyeonghoekim,2 ilhoonsung,3 dongwoojang,4 jungsooyoon,1 younhwankim,1 andsangwhakim 2. Among the more common types of flaps that are used for tissue reconstruction at our institution are the deep inferior epigastric perforator flap, the superior gluteal artery perforator flap, the anterolateral thigh flap, the transverse upper gracilis flap, the thoracodorsal artery perforator flap, and the fibula free flap. This flap which was supplied by thoracodorsal artery retained latissimus dorsi muscle and thoracodorsal nerve, so it was suitable for repair of trunk and limb defects in pedicled or free form, and also for repair of maxillary defect with. Visualized bilateral breast reconstruction by propeller.
Angrigiani editorial comment this is a reasonably reliable flap, with consistent anatomy. Research open access thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix tarek hashem1,2 and ahmed farahat1 abstract background. Preoperative ultrasonography or computed tomography angiography is usually used to help identify perforators on which to base. The ld flap has, however, shown an accumulation of donorsite morbidity such as chronic pain, seroma. Request pdf clinical application of the thoracodorsal artery perforator flaps. Use of thoracodorsal artery perforator flaps to enhance outc.
Successful correction of postburn mentosternal contracture. The diep flap is the technique where skin and tissue no muscle is taken from the abdomen in order to recreate the breast. The thoracodorsal artery perforator tdap flap is based on the branches of the thoracodorsal artery as they pass through the latissimus dorsi to perfuse the overlying soft tissue. It is a flap that should be used more frequently than it is. Transaxillary thoracodorsal artery perforator flap. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Twenty latissimus dorsi flaps harvested from cadavers were used in the study. The objective of this study was to document the vascular anatomy of this. Comparison of radial forearm flap and thoracodorsal artery. Here we present a chimeric, thoracodorsal perforatorscapular free flap based on the angular artery of the subscapular system tdapscapaa as an alternative technique for single flap reconstruction of extensive oromandibular defects. The thoracodorsal artery perforator tdap flap has emerged as one of the ideal perforator flaps. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic d. Free thoracodorsal, perforatorscapular flap based on the.
Thoracodorsal artery perforator tdap flap is one of the relatively new techniques in breast. We report a successful case of anterior chest wall reconstruction with a composite thoracodorsal artery perforator tdap free flap with sixth and seventh vascularized ribs. The free thoracodorsal artery perforator flap in head and. Figure 1 a horizontal design of the thoracodorsal artery perforator flap. Use of thoracodorsal artery perforator flaps to enhance. Thoracodorsal artery perforator flap and latissimus dorsi. Latissimus dorsi thoracodorsal artery perforator flap ent. Transcervical view of the defect following subtotal glossectomy with sparing of the right base of tongue bot. Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise.
We, hereby, describe its versatility in indications free pedicled, methods of harvest patient position and paddle orientation and perforator consistency. Ischaemic flap complications can be a problem following harvest of the latissimus dorsi ld musculocutaneous flap or thoracodorsal artery perforator tap flap. Transverse sensate thoracodorsal artery perforator flap. Alt, sgap superior gluteal artery perforator flap, igap inferior gluteal artery perforator flap, and tdap toracodorsal artery perforator flap have been described as pedicled propeller flaps for reconstruction of difficult wounds of axillary, gluteal, or inguinal regions following resection of hidradenitis suppurativa 6, 3437. Partial ld flaps have been used for facial reanimation as have perforator flaps based on the thoracodorsal artery tda creating a tdap flap. The pattern of the thoracodorsal artery in the latissimus dorsi muscle the present study showed that of all the 60 dissections made, the thoracodorsal artery divided into a medial and a lateral branch, and ran on the deep surface of the muscle. Chimeric flaps are often used in reconstructive fields for multiple defects, different functional defects, and extensive defects. However, this could be overcome by training and experience 11. Another significant technique to protect the lower pole of the implant pocket is. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels.
Song, md, facsb adivision of pediatric plastic surgery, the childrens memorial hospital, chicago, ill. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. Thoracodorsal artery an overview sciencedirect topics. The thoracodorsal artery perforator flap first reported by angrigiani was based on the latissimus dorsi myocutaneous flap. Of the 792 autologous free flap breast reconstruction performed, we identified 12 patients 21 flaps who underwent reconstruction using thoracodorsal or. Free tissue transfer can be useful for complicated wounds. Pdf transaxillary thoracodorsal artery perforator flap.
Algorithm for autologous breast reconstruction for partial. However, searching for a reliable perforator and the tedious process of intramuscular retrograde dissection of the perforator are timeconsuming and skilldemanding. Thoracodorsal artery perforator flap sandy dast, md, pascal berna, md. We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for. We report here on the results of the reconstruction in this region using free thoracodorsal artery perforator flaps. The perforating branches of the thoracodorsal artery offer a robust blood supply to a skinsofttissue paddle of 10 to 12 cm. We, hereby, describe its versatility in indications freepedicled, methods of harvest patient position and paddle orientation and perforator consistency. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required.
The dominant perforator is traced through the muscle to the descending branch of the thoracodorsal artery. The branch of the thoracodorsal artery perforator pedicle that entered the perforators to the skin paddles was dissected. Plantar reconstruction with free thoracodorsal artery. Pedicled thoracodorsal artery perforator flap in breast. Request pdf thoracodorsal artery perforator flap for partial breast reconstruction the popularity of breast conservation therapy bct for the management of women with breast cancer continues. Preoperative imagebased treatment planning is a crucial part of flap design.
Pedicled thoracodorsal artery perforator flap in breast reconstruction. We have used the thoracodorsal artery perforator flap to reconstruct. Reconstruction of the lateral malleolus and calcaneus. However, preoperative irradiation increases the complication rate and thus some consider preoperative radiotherapy a relative contraindication to alloplastic alone reconstruction. Like a split ld flap, a thoracodorsal artery perforator flap 1518 can be used to repair partial breast defects without compromising function of the remaining ld muscle. It is hoped that the constant anatomy will encourage surgeons in the future to use the thoracodorsal artery perforator flap more often. This is the most common procedure performed at our breast center as women generally have excess skin and fat along the lower portion of their abdomen. Transverse or oblique orientation of flap design is advocated for better coverage of perforasome and dermatome and more acceptable donor site scar. Between january 2007 and february 2016, 10 thoracodorsal artery perforator tdap free flaps were performed. A cutaneous nerve may be seen accompanying the largest perforator. The thoracodorsal artery perforator flap request pdf. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic devices has been proven to be a safe method of breast reconstruction. Symmetrical peripheral gangrene spg is rare but devastating complication which is characterized by symmetrical ischemic change of the distal extremities.
The purpose of this study was to evaluate the cosmetic results of radial forearm and thoracodorsal artery perforator free. This flap is the equivalent of the latissimus myocutaneous flap without the inclusion of the musculature of the latissimus. The purpose of this study was to report our experience with the free thoracodorsal artery perforator flap for reconstruction of the oropharynx and soft palate in. The thoracodorsal artery perforator tdap flap is a musclesparing skin and fat flap that requires careful and precise dissection of the thoracodorsal td artery perforators, which are found deep in the underlying muscle or intermuscular septa.
In this report, we describe our management protocol for spg, focusing on surgical approaches. Free thoracodorsal artery perforator flap in extremity. Algorithm for autologous breast reconstruction for partial mastectomy defects joshua l. Thoracodorsal artery perforator flap tap flap microsurgeon. Thoracodorsal artery perforator flap for partial breast. The free thoracodorsal artery perforator flap offers a long donor vessel that can reach the recipient vessel distant to traumatized or irradiated defects, homogeneous flap thinness that can be used for resurfacing shallow. Thoracodorsal artery perforator flap for extremity. The anatomy of the thoracodorsal artery in perforator flap. Thoracodorsal artery perforator tdap flap is one of the relatively new. If muscle was required, other branches of the thoracodorsal artery, such as transverse branches feeding the ld muscle, could be harvested with ld muscle flaps in a chimeric pattern.
416 517 472 139 154 1475 1036 1458 1058 1279 44 384 886 760 265 841 1470 922 195 975 532 766 613 217 462 1308 179 855 902 362 201 526 331 540 759 859 1285 1578 560 479 1442 464 1045 67 856 199 1391 1221 778 1066