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The Thoracodorsal Artery Perforator Flap: Clinical Experience and Anatomic Study with Emphasis on Harvest Techniques

Guerra, Aldo Benjamin M.D.; Metzinger, Stephen Eric M.D.; Lund, Kiersten Maria M.D.; Cooper, Michelle Maria M.D.; Allen, Robert Johnson M.D.; Dupin, Charles Louis M.D.

Plastic and Reconstructive Surgery: July 2004 - Volume 114 - Issue 1 - p 32-41
doi: 10.1097/01.PRS.0000129071.03842.C5
Original Articles

The thoracodorsal artery perforator flap is a relatively new flap that has yet to find its niche in reconstructive surgery. At the authors’ institution it has been used for limb salvage, head and neck reconstruction, and trunk reconstruction in cases related to trauma, burns, and malignancy. The authors have found the flap to be advantageous for cranial base reconstruction and for resurfacing the face and oral cavity. The flap has been used successfully for reconstruction of traumatic upper and lower extremity defects, and it can be used as a pedicled flap or as a free tissue transfer. The perforating branches of the thoracodorsal artery offer a robust blood supply to a skin–soft-tissue paddle of 10 to 12 cm × 25 cm, overlying the latissimus dorsi muscle. The average pedicle length is 20 cm (range, 16 to 23 cm), which allows for a safe anastomosis outside the zone of injury in traumatized extremities; the flap can be made sensate by neurorrhaphy with sensory branches of the intercostal nerves. Vascularized bone can be transferred with this flap by taking advantage of the inherent vascular anatomy of the subscapular artery. A total of 30 pedicled and free flap transfers were performed at the authors’ institution with an overall complication rate of 23 percent and an overall flap survival rate of 97 percent. Major complications, such as vascular thrombosis, return to the operating room, fistula formation, recurrence of tumor, and flap loss, occurred in 17 percent of the patients. Despite these drawbacks, the authors have found the thoracodorsal artery perforator flap to be a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction cases.

New Orleans, La.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center.

Received for publication June 11, 2002; revised August 15, 2003.

Aldo Benjamin Guerra, M.D.

Department of Surgery, Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Cent, 1542 Tulane Avenue, Room 701, New Orleans, La. 70112

©2004American Society of Plastic Surgeons