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Sensate Thoracodorsal Artery Perforator Flap: A Focus on Its Preoperative Design and Harvesting Technique

Lin, Cheng-Ta M.D.; Yang, Kuo-Chung M.D.; Hsu, Kuei-Chang M.D.; Liu, Wen-Chung M.D.; Chen, Jin-Shyr M.D.; Chen, Lee-Wei M.D., Ph.D.

Plastic and Reconstructive Surgery: January 2009 - Volume 123 - Issue 1 - p 163-174
doi: 10.1097/PRS.0b013e3181909c34
RECONSTRUCTIVE: TRUNK: ORIGINAL ARTICLES
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Background: Free sensate thoracodorsal artery perforator flaps that include the posterior divisions of the lateral cutaneous branches of the intercostal nerves have been described. The authors used preoperative color Doppler sonography to identify the nerves and demonstrate its clinical value.

Methods: Fourteen free sensate thoracodorsal artery perforator flaps were collected. Preoperative color Doppler sonography was used to identify the locations of thoracodorsal artery perforators and the courses of the posterior divisions of the lateral cutaneous branches of the intercostal neurovascular bundles. These posterior divisions were preserved on flaps and classified into three types. Type A and B nerves sprouted cutaneous perforating fascicles over the lateral region of the latissimus dorsi muscle. Type C nerves went through the region without any dominant perforating fascicle.

Results: Twenty-one nerves were mapped, and 24 were found during surgery. The sensitivity of preoperative color Doppler sonography was 87.5 percent. Of the 24 nerves, nine were type A (37.5 percent), 12 were type B (50 percent), and three were type C (12.5 percent). Ten of the 14 patients (sensate group) showed better tactile recovery at both the center and the periphery of flap than the other 10 patients who underwent reconstruction with nonsensate flaps.

Conclusions: Preoperative color Doppler sonography is an indispensable tool for sensate thoracodorsal artery perforator flaps in locating the perforators and mapping the posterior divisions of the lateral cutaneous branches of the intercostal nerves. The information can be used to design and harvest sensate thoracodorsal artery perforator flaps, which are associated with earlier and better tactile recovery.

Kaohsiung and Taipei, Taiwan

From the Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, and National Yang-Ming University School of Medicine.

Received for publication April 15, 2008; accepted July 8, 2008.

Disclosure:None of the authors has a conflict of interest to disclose.

Lee-Wei Chen, M.D., Ph.D.; Division of Plastic and Reconstructive Surgery; Kaohsiung Veterans General Hospital; 386 Ta-Chung 1st Road; Kaohsiung, Taiwan 813-46, Republic of China; asacol.tw@yahoo.com.tw

©2009American Society of Plastic Surgeons