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Three- and Four-Dimensional Arterial and Venous Anatomies of the Thoracodorsal Artery Perforator Flap

Schaverien, Mark M.R.C.S.; Saint-Cyr, Michel M.D.; Arbique, Gary Ph.D.; Brown, Spencer A. Ph.D.; Rohrich, Rod J. M.D.

Plastic & Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - pp 1578-1587
doi: 10.1097/PRS.0b013e31816b1479
Experimental: Original Articles

Background: The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three- and four-dimensional computed tomographic angiography and venography.

Methods: Twenty-five thoracodorsal artery perforator flaps were harvested from fresh cadavers from the Western population. Dynamic static computed tomographic angiography using iodinated contrast media was performed following cannulation of the largest perforator from the descending branch of the thoracodorsal artery and its vena comitans in 10 flaps. Imaging was repeated subsequent to flap thinning between the deep and superficial adipose layers. Colored latex injections and flap dissections were performed in a further 15 flaps to establish the location, caliber, and intramuscular length of the thoracodorsal artery perforators.

Results: Two distinct perforator complex types were described. Flap thinning can be safely performed between the deep and superficial adipose layers without significantly affecting flap vascularity, provided that a safety zone about the perforator is respected. The superficial venous system consisted of large veins arranged in a polygonal pattern situated at the subdermal level and was connected to the deep system by the venae comitantes of the thoracodorsal artery perforators. Perforators from the descending branch of the thoracodorsal artery were found in reliable locations.

Conclusions: Using a novel dynamic three-dimensional imaging technique, perfusion of the arterial and venous system of the thoracodorsal artery perforator flap was elucidated. Although the flap is inherently thin, it can be safely thinned between the superficial and deep adipose layers. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction.

Dallas, Texas

From the Department of Plastic Surgery and Department of Medical Physics, Division of Radiology, University of Texas Southwestern Medical Center.

Received for publication June 4, 2007; accepted August 29, 2007.

Presented at the 23rd Annual Scientific Meeting of the American Society for Reconstructive Microsurgery, in Los Angeles, California, January 14th, 2008.

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Michel Saint-Cyr, M.D.; Department of Plastic Surgery; University of Texas Southwestern Medical Center; 1801 Inwood Road; Dallas, Texas 75390-9132; michel.saint-cyr@utsouthwestern.edu

Disclosure: The authors have no financial interests in this research project or in any of the techniques or equipment used in this study.

©2008American Society of Plastic Surgeons