Sever c, uygur f, kulahci y, karagoz h, sahin c objective. Lateral intercostal artery perforatorbased reversed thoracodorsal artery flap for reconstruction of a chronic radiation ulcer of the lower. The inthecrease inferior gluteal artery perforator flap. The thoracodorsal and lateral thoracic artery perforator flaps are highly studied, and successful clinical series have been reported, whereas the literature concerning the lateral intercostal and serratus anterior artery perforator flaps is quite poor and their vascular anatomy needs yet to be clarified. Compared to latissimus dorsi myocutaneous flaps and scapular flaps, 20 thoracodorsal artery flap has several advantages. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires breast plastic and reconstructive surgeons at johns hopkins medicine also. Thoracodorsal artery perforator fasciocutaneous flap. The objective of this study was to document the vascular anatomy of this. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. It has been championed as an alternative to the tug flap. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. Nowadays, pedicle perforator flaps have been described for partial breast mastectomy reconstruction the study comprised all patients who received partial breast resection due to external quadrant breast cancers and who were reconstructed with thoracodorsal perforator flap between august 2010 and.
We present our strategies in sparing the ld muscle by using the tdap flap with an implant beneath. However, this could be overcome by training and experience 11. However, there are few reports about the role of this flap in total. Jun 22, 20 anatomy of the latissimus dorsi muscle everything you need to know dr. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. Chang performed an anatomic study in 1990 to show that the pivot point of the pedicle was located 1.
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 flap was transposed onto the breast anterolateral and posterolateral chest wall. In none of our cases was the latissimus dorsi muscle included. However, the tdap has never been used together with implant for. Angrigiani et al 1 first described harvesting a cutaneous island of the latissimus dorsi flap without the muscle based on one cutaneous perforator. The thoracodorsal artery perforator tdap flap is a versatile tool in reconstructive surgery and its use in breast reconstruction is becoming increasingly popular. Breast reconstruction following mastectomy or lumpectomy.
Even in those cases, small capillary perforators exist around the proximal portion of the lateral border of the latissimus dorsi muscle, and they have a potential of a large skin territory. Women with unfavorable defects will often benefit from volume replacement technique, such as pedicled perforator flaps. It is a flap that should be used more frequently than it is. The virtue of this flap is its uniform thinness and its adaptability. Oct 14, 2012 oncoplastic approach to reconstruct partial breast resection is always challenging.
Thoracodorsal artery perforator tdap flap is one of the relatively new techniques in breast reconstruction. Versatility of the pedicled thoracodorsal artery perforator. Oncoplastic approach to reconstruct partial breast resection is always challenging. The thoracodorsal artery perforator tdap flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels. Angrigiani editorial comment this is a reasonably reliable flap, with consistent anatomy. Since then, several studies have demonstrated that the use of musclesparing latissimus dorsiflap is feasible and ensures excellent objective and subjective aesthetic outcomes without contour. Perforator flaps have become very popular in reconstructive surgery. Thoracodorsal artery perforator tap flap is not yet popularised because the dominant large muscle perforators are often absent. Drawbacks include an inconsistent dominant perforator location need for preoperative studies and a narrow flap width limiting donor tissue volume. Case report a double thoracodorsal artery perforator flap. Surgical atlas of perforator flaps download ebook pdf.
Use of a skin perforator flap pedicled by the intercostal. The thoracodorsal artery perforator tdap flap has been described for breast reconstruction. The inthecrease inferior gluteal artery perforator flap for. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic devices has been proven to be a safe method of breast reconstruction. Pdf first metatarsal artery capillary perforator flaps. It yields a relatively long, thin and pliable skin flap and a. In our department, the thoracodorsal artery perforator tdap flap is widely used as free flap for large defects on extremities. The donor site can usually be closed, and the scar is not objectionable. The latissimus dorsi ld musculocutaneous flap with implant has been widely used for breast reconstruction. Breast reconstruction, perforator flaps, nipplesparing mastectomy, thoracodorsal artery, subpectoral. Anatomy as described by cormack and lamberty and confirmed by angrigiani et. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated.
Erratum to propeller thoracodorsal artery perforator flap. The thoracodorsal artery perforator tdap flap has emerged as one of the ideal perforator flaps. Extended thoracodorsal artery perforator flap for breast reconstruction a total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. New thoracodorsal artery perforator tapcp flap with.
Large when taken up to the thoracodorsal or subscapular system. This flap requires intramuscular dissection of the pedicle. Surgical atlas of perforator flaps download ebook pdf, epub. Propeller thoracodorsal artery perforator flap for breast. Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise. Breast reconstruction following mastectomy or lumpectomy is considered medically necessary for. A modification of the conventional tdap surgical technique for breast reconstruction is described, utilizing instead a. Clinical application of the thoracodorsal artery perforator flaps. The thoracodorsal artery perforator flap request pdf. A cutaneous nerve may be seen accompanying the largest perforator. A total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. Above, left the arc of rotation for the thoracodorsal artery perforator flap. The lateral thoracic flap is elevated based on the thoracodorsal artery perforator. Methods we included ten consecutive patients requiring axillary reconstruction with thoracodorsal artery perforator flap, from june 2017 to june 2018.
Erratum to propeller thoracodorsal artery perforator flap for breast reconstruction in the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors. Postoperative anterior view c shows optimal evolution of the cutaneous flap island. 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. Thoracodorsal artery perforator flap for reconstruction. The flap can be thinned considerably in the level of the superficial adipose layer, which is very useful for tongue reconstruction figure 6. Normally, reconstruction following neck contracture release with stsgs produces poor results due to an elevated rate of recontractures. Perforator flap definition of perforator flap by medical. Use of the thoracodorsal artery perforator tdap flap with. 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. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. Superficial circumflex iliac artery perforator scip flap presenter. This flap is the equivalent of the latissimus myocutaneous flap without the inclusion of the musculature of the latissimus.
Use of lateral intercostal artery perforator free flaps for resurfacing lower extremities. The axillary region is one of the sites most frequently affected by postburn contractures. In the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction was published with some errors the legends of preoperative a marks. Onestage reconstruction of neck burns with single layer. The radial artery perforator rap flap with preservation of the radial artery was firstly reported by zhang for hand reconstruction. Anatomy of the latissimus dorsi muscle everything you need to know dr. In the reported case, the vascularity of the flap was improved by including a thoracodorsal artery perforator. Freestyle local perforator flaps for facial reconstruction. Bilateral foot defect thoracodorsal artery perforator flap for right foot and latissimus dorsi muscle flap with split thickness skin grafts for the left foot. Reconstruction of an extended defect in the axilla using a. Pectus excavatum is a common congenital deformity involving the anterior thoracic wall.
Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. The limberg flap as a random flap is easy and practicable for coverage of many defects including those involving the axilla. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper.
Thoracodorsal artery an overview sciencedirect topics. The lateral intercostal artery perforator as an mafiadoc. Use of thoracodorsal artery perforator flaps to enhance. Thoracodorsal artery perforator tdap flap in immediate. Its role in partial breast reconstruction has been well documented. Ectopic primary carcinoma of breast tissue is a rare entity, and its diagnosis often is delayed. The inthecrease inferior gluteal artery perforator flap from the buttock is now the authors primary alternative to the deep inferior epigastric perforator flap from the abdomen for breast reconstruction. It can be treated with several surgical approaches. Thoracodorsal artery perforator flap dissected and deepithelialized b.
The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. The detailed surgical technique with its variations is. This atlas is organized in a way with a combination of basic theory and clinical practices, and of real photos and text description in perforator flap. Read thoracodorsal artery perforator tdap flap in immediate breast reconstruction and the role of preoperative mapping. The thoracodorsal artery perforator flap with capillary perforators tapcp is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can. Five patients with severe axillary burn contractures were reconstructed with six pre. The dominant perforator is traced through the muscle to the descending branch of the thoracodorsal artery. Autologous breast reconstruction with the thoracodorsal artery perforator flap is described including indications, preoperative marking, key intraoperative steps including a dictation example, postoperative care, and coding. This flap was originally described in 1995 as a method for. Thoracodorsal artery perforator flap for partial breast. With this concept, operations were carried out on the basis of facial artery perforators, nasolabial artery perforators, postauricular artery perforators, or submental artery.
Erratum to propeller thoracodorsal artery perforator flap for. Nowadays, pedicle perforator flaps have been described for partial breast mastectomy reconstruction the study comprised all patients who received partial breast resection due to external quadrant breast cancers and who were reconstructed with thoracodorsal perforator flap between august 2010 and august 2011. We, hereby, describe its versatility in indications freepedicled, methods of harvest patient position and paddle orientation and perforator consistency. Thoracodorsal artery perforator flap for reconstruction department of plastic surgery, louisiana state university medical center, new orleans. Muscle electrical activity after perforator flap surgery. However, preoperative irradiation increases the complication rate and thus some consider preoperative radiotherapy a relative contraindication to alloplastic alone reconstruct. However, the tdap has never been used together with implant for breast reconstruction.
Extended thoracodorsal artery perforator flap for breast. P erforator free flaps harvested from the abdomen or buttock have been shown to be. Sep 1996 kamran khoobehi, md, robert allen, md, and walton j. Dec 06, 2017 erratum to propeller thoracodorsal artery perforator flap for breast reconstruction in the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors.
The anatomy of the thoracodorsal artery in perforator flap. To our best of knowledge, this is the first case of pectus excavatum repair via a 2stage double thoracodorsal artery perforator flap procedure in a 37yearold patient. Although some reports indicate that freestyle perforator flaps have been used to cover defects of the trunk or extremities, the use of such flaps for facial reconstruction was only recently introduced. A modification of the conventional tdap surgical technique for breast reconstruction is described, utilizing instead a propeller tdap flap. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Careful preoperative perforator mapping and a standardized approach to flap planning and harvest can significantly reduce the difficulty of executing pedicled thoracodorsal artery perforator flaps. The thoracodorsal artery perforator tdap flap spares the ld muscle. Haq eu, javaid rh, hameed s, saood r, majid a, waqas m, aslam a, yusuf o background.
The optimal reconstruction method should provide thin, and wellv. The skin paddle can be from 18 cm wide and up to 55 cm long can be harvested on a single perforator. Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. First, it offers a larger and thinner flap without latissimus dorsi muscle, with thickness of the flap approximately 0. Extended thoracodorsal artery perforator flap for breast reconstruction.
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