Thoracodorsal artery perforator flap dissected and deepithelialized b. Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise. 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. The lateral thoracic flap is elevated based on the thoracodorsal artery perforator. Use of the thoracodorsal artery perforator tdap flap. Ectopic primary carcinoma of breast tissue is a rare entity, and its diagnosis often is delayed. 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. 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. Oncoplastic approach to reconstruct partial breast resection is always challenging. However, there are few reports about the role of this flap in total.
This flap was originally described in 1995 as a method for. The dominant perforator is traced through the muscle to the descending branch of the thoracodorsal artery. P erforator free flaps harvested from the abdomen or buttock have been shown to be. However, preoperative irradiation increases the complication rate and thus some consider preoperative radiotherapy a relative contraindication to alloplastic alone reconstruction. Its role in partial breast reconstruction has been well documented. However, the tdap has never been used together with implant for breast reconstruction. It yields a relatively long, thin and pliable skin flap and a good aesthetic result.
Sep 1996 kamran khoobehi, md, robert allen, md, and walton j. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. The skin paddle can be from 18 cm wide and up to 55 cm long can be harvested on a single perforator. 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. 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. Anatomy of the latissimus dorsi muscle everything you need to know dr. Compared to latissimus dorsi myocutaneous flaps and scapular flaps, 20 thoracodorsal artery flap has several advantages. Breast reconstruction following mastectomy or lumpectomy is considered medically necessary for. The flap was transposed onto the breast anterolateral and posterolateral chest wall. Lateral intercostal artery perforatorbased reversed thoracodorsal artery flap for reconstruction of a chronic radiation ulcer of the lower. Extended thoracodorsal artery perforator flap for breast. 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.
Bilateral foot defect thoracodorsal artery perforator flap for right foot and latissimus dorsi muscle flap with split thickness skin grafts for the left foot. The thoracodorsal artery perforator tdap flap is a versatile tool in reconstructive surgery and its use in breast reconstruction is becoming increasingly popular. The anatomy of the thoracodorsal artery in perforator flap. The operative plan is to excise the infected skin and reconstruct the defect using a thoracodorsal artery perforator flap. The thoracodorsal artery perforator tdap flap spares the ld muscle. This flap is the equivalent of the latissimus myocutaneous flap without the inclusion of the musculature of the latissimus. A cutaneous nerve may be seen accompanying the largest perforator. Case report a double thoracodorsal artery perforator flap.
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. Chang performed an anatomic study in 1990 to show that the pivot point of the pedicle was located 1. Thoracodorsal artery perforator flap for reconstruction department of plastic surgery, louisiana state university medical center, new orleans. Pdf first metatarsal artery capillary perforator flaps. Five patients with severe axillary burn contractures were reconstructed with six pre. However, preoperative irradiation increases the complication rate and thus some consider preoperative radiotherapy a relative contraindication to alloplastic alone reconstruct. Methods we included ten consecutive patients requiring axillary reconstruction with thoracodorsal artery perforator flap, from june 2017 to june 2018. New thoracodorsal artery perforator tapcp flap with.
The thoracodorsal artery perforator flap request pdf. 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. Drawbacks include an inconsistent dominant perforator location need for preoperative studies and a narrow flap width limiting donor tissue volume. Reconstruction of an extended defect in the axilla using a. 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. Erratum to propeller thoracodorsal artery perforator flap for.
Note the muscle fibers of the anterior edge of the latissimus dorsi are separated in order to expose the perforator to its source vessel, as well as to create a portal through which the flap may be delivered to its recipient site under the breast. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. Above, left the arc of rotation for the thoracodorsal artery perforator flap. Oct 14, 2012 oncoplastic approach to reconstruct partial breast resection is always challenging. Thoracodorsal artery perforator flap for partial breast. Normally, reconstruction following neck contracture release with stsgs produces poor results due to an elevated rate of recontractures. Perforator flaps have become very popular in reconstructive surgery. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix. 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. Surgical atlas of perforator flaps download ebook pdf, epub. It is a flap that should be used more frequently than it is. Women with unfavorable defects will often benefit from volume replacement technique, such as pedicled perforator flaps.
Large when taken up to the thoracodorsal or subscapular system. Propeller thoracodorsal artery perforator flap for breast. 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. Pectus excavatum is a common congenital deformity involving the anterior thoracic wall. The limberg flap as a random flap is easy and practicable for coverage of many defects including those involving the axilla. It yields a relatively long, thin and pliable skin flap and a. It can be treated with several surgical approaches.
The donor site can usually be closed, and the scar is not objectionable. Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper. The axillary region is one of the sites most frequently affected by postburn contractures. Thoracodorsal artery perforator tap flap is not yet popularised because the dominant large muscle perforators are often absent. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. 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. The flap can be thinned considerably in the level of the superficial adipose layer, which is very useful for tongue reconstruction figure 6. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue.
It has been championed as an alternative to the tug 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. The lateral intercostal artery perforator as an mafiadoc. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Postoperative anterior view c shows optimal evolution of the cutaneous flap island. Angrigiani et al 1 first described harvesting a cutaneous island of the latissimus dorsi flap without the muscle based on one cutaneous perforator. The radial artery perforator rap flap with preservation of the radial artery was firstly reported by zhang for hand reconstruction. Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required.
Haq eu, javaid rh, hameed s, saood r, majid a, waqas m, aslam a, yusuf o background. However, the tdap has never been used together with implant for. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Anatomy as described by cormack and lamberty and confirmed by angrigiani et. 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. Thoracodorsal artery an overview sciencedirect topics. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. Freestyle local perforator flaps for facial reconstruction. Versatility of the pedicled thoracodorsal artery perforator. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. In our department, the thoracodorsal artery perforator tdap flap is widely used as free flap for large defects on extremities. Jun 22, 20 anatomy of the latissimus dorsi muscle everything you need to know dr. Use of thoracodorsal artery perforator flaps to enhance. 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 contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. First, it offers a larger and thinner flap without latissimus dorsi muscle, with thickness of the flap approximately 0. 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.
The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels. 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. The optimal reconstruction method should provide thin, and wellv. 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. The detailed surgical technique with its variations is. In the reported case, the vascularity of the flap was improved by including a thoracodorsal artery perforator. Use of the thoracodorsal artery perforator tdap flap with. Breast reconstruction, perforator flaps, nipplesparing mastectomy, thoracodorsal artery, subpectoral. 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.
Erratum to propeller thoracodorsal artery perforator flap. The virtue of this flap is its uniform thinness and its adaptability. Extended thoracodorsal artery perforator flap for breast reconstruction. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. This flap requires intramuscular dissection of the pedicle. Perforator flap definition of perforator flap by medical. Muscle electrical activity after perforator flap surgery. Use of lateral intercostal artery perforator free flaps for resurfacing lower extremities.
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. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic devices has been proven to be a safe method of breast reconstruction. Thoracodorsal artery perforator flap as an autologous. The latissimus dorsi ld musculocutaneous flap with implant has been widely used for breast reconstruction. The thoracodorsal artery perforator tdap flap has emerged as one of the ideal perforator flaps. Clinical application of the thoracodorsal artery perforator flaps. A modification of the conventional tdap surgical technique for breast reconstruction is described, utilizing instead a. The inthecrease inferior gluteal artery perforator flap. The inthecrease inferior gluteal artery perforator flap for. In none of our cases was the latissimus dorsi muscle included.
The objective of this study was to document the vascular anatomy of this. Thoracodorsal artery perforator flap for reconstruction. We, hereby, describe its versatility in indications freepedicled, methods of harvest patient position and paddle orientation and perforator consistency. With this concept, operations were carried out on the basis of facial artery perforators, nasolabial artery perforators, postauricular artery perforators, or submental artery. The thoracodorsal artery perforator tdap flap has been described for breast reconstruction. Angrigiani editorial comment this is a reasonably reliable flap, with consistent anatomy. Thoracodorsal artery perforator tdap flap is one of the relatively new techniques in breast reconstruction.
Thoracodorsal artery perforator tdap flap in immediate. Onestage reconstruction of neck burns with single layer. 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. Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. A modification of the conventional tdap surgical technique for breast reconstruction is described, utilizing instead a propeller tdap flap. Breast reconstruction following mastectomy or lumpectomy. 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. 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. However, this could be overcome by training and experience 11. Thoracodorsal artery perforator fasciocutaneous flap. We present our strategies in sparing the ld muscle by using the tdap flap with an implant beneath.
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