Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume

Dast, S.; Havet, É.; Dessena, Lidia; Abdulshakoor, Abeer; Alharbi, Mohammed; Vaucher, Richard; Herlin, Christian; Sinna, R.

doi:10.1007/s00276-016-1811-x

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…16 The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery. 17 The LD flap is a fan-shaped flap that offers the advantages of providing a muscle rich in blood supply, providing a bulky flap no matter the defect, and causing little problem in the activities of daily living due to few donor site complications. 18,19 Owing to such advantages, it is a flap used not only in breast reconstruction, but also in the reconstruction of large and complex tissue defects in the maxillofacial region.…”

Section: Discussionmentioning

confidence: 99%

“…16 The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery. 17…”

Section: Discussionmentioning

confidence: 99%

“…for use on soft tissues and fibula only, deep circumflex iliac artery, and scapula flaps that include bone are available, wherein each flap is observed to have its own advantages and disadvantages 31 . The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery 15 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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BACKGROUND The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest CT angiography. PATIENTS AND METHODS We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. RESULTS 700 blood vessels were classified according to the KNUPS TDA classification, 388 (185 Rt. and 203 Lt.), 126 (64 Rt. and 62 Lt.), 91 (49 Rt. and 42 Lt.), 57 (27 Rt. and 30 Lt.), and 38 (25 Rt. and 13 Lt.) vessels were classified as Type I, II, III, IV, and V, respectively. Among 350 patients, 205 patients showed matching types for Lt. and Rt. vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with Type I, II, III, IV, and V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with Types I+II, I+III, I+IV, I+V, II+III, II+IV, II+V, III+IV, III+V, and IV+V, respectively. CONCLUSIONS While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.

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Section: Discussionmentioning

confidence: 99%

“…16 The most important factor in flap surgery is the main pedicle of the flap; thus, an accurate knowledge of vascular anatomy is very important and fundamental in flap surgery. 17…”

Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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“… 36 , 37 In 2015, Gunnarsson et al 38 and Angrigiani et al 39 described the extended version of the TDAP flap, which included additional fat tissue on each side of the skin paddle to allow for a more voluminous flap. Dast et al, 36 in a recent anatomical study, reported that the TDAP flap via the deep muscular fascial network allows for a harvest flap with a mean surface of 441 cm 2 and a mean volume of 193 g. In select cases, the TDAP flap can also achieve total breast reconstruction alone or in combination with fat grafting. 19 In our review, partial breast defects varied from lumpectomy to outer columnar mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Mangialardi

Baldelli

Salgarello

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Introduction: Breast conserving surgery followed by radiation therapy represents the standard of care for early stage breast cancer. Oncoplastic breast surgery includes several reconstructive techniques essentially summarized in 2 categories: volume displacement and volume replacement procedures. These latest procedures have evolved over time from the use of the entire latissimus dorsi muscle to the use of pedicled perforator flaps, namely the thoracodorsal artery perforator (TDAP) flap. The aim of this article is to provide a comprehensive review of the literature regarding the use of the TDAP flap in partial breast defects. Methods: A literature search was performed via PubMed, Medline, and Cochrane. Studies reporting the use of the TDAP flap after breast conserving surgery were included. Patient characteristics, topography and size of breast defect, flap size and design, number of perforators, and operative time were analyzed. Moreover, aesthetic and functional (shoulder morbidity) results, patient satisfaction, postoperative complications, and donor site morbidity were registered. Results: Twelve articles fulfilled inclusion criteria, and 337 patients were included. All articles except 1 described the use of the TDAP flap for defects in every breast quadrant. The mean weight of resected breast tissue was 97.28 g, and patients with over 20% of volume deficiency were considered eligible for TDAP flap volume replacement. The ellipse-shaped skin paddle (oriented oblique downward, transversal or oblique upward in most cases) was extended over the anterior border of the latissimus dorsi muscle to include possible septocutaneous perforator vessels. Most authors began the dissection from the anterior and caudal border of the flap to reserve the possibility to convert the TDAP to a musculocutaneous flap and check for septocutaneous perforators. Flap size ranged from 4 × 12 to 21 × 9 cm. The mean procedure time was 192.21 minutes. Mean follow-up was 17.42 months. Evaluation by way of a 5-point Likert scale reported overall mean values of over 4 points. Satisfactory outcomes were reported in 92.85%–100% of cases. Patient satisfaction ranged from 80% to 94% of cases. The incidence of seroma (1 case) and “shoulder-related” donor site morbidity was very low. Conclusions: Despite the heterogeneity of the evaluation methods, our review suggested that the use of the TDAP flap in oncoplastic surgery allows for satisfactory aesthetic outcomes and quite high levels of patient satisfaction. The TDAP flap represents an effective and versatile tool that amplifies the oncoplastic surgeon’s arsenal, which allows for satisfactory outcomes.

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“…It has been reported that the vascular territory of TDA perforators includes adipose tissue beyond the lateral border of the LD muscle, and free adipose flaps that use TDA septocutaneous perforators have been reported. 14 , 15 In the present study, we avoided skeletonizing the performing vessels in adipose flap during surgery, and efforts were made to preserve the network of blood vessels between the tissues by elevating the adipose flap and LD muscle as a single unit (Figs. 1 and 2 ).…”

Section: Methodsmentioning

confidence: 99%

Scarless Donor Site for Breast Reconstruction by Endoscopically Assisted Extended Latissimus Dorsi Flap plus Lipofilling

Akita

Tokumoto

Yamaji

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Breast reconstruction using endoscopically assisted latissimus dorsi (LD) flap leaves no scar on the back; however, the small amount of tissue obtained makes this procedure less practical. This study aimed to propose a new technique of endoscopically assisted extended LD (eeLD) flap plus lipofilling, which could secure a large breast volume. Methods: Lateral thoracic adipose tissues supplied by the thoracodorsal artery branches and the LD muscle were elevated as a single unit only through the mastectomy scar and three ports through the lateral chest. Furthermore, fat was simultaneously injected to support the volume and shape of the breast. Changes in the volume of the reconstructed breast over time were measured using three-dimensional stereophotogrammetry. Results: Overall, 15 breasts of 14 patients who underwent breast reconstruction using an eeLD flap exhibited no serious complications. On average, 281.9 ± 32.4 g of flap and 74.7 ± 19.4 mL of lipofilling were used. Within 8 weeks after the procedure, the volume of the reconstructed breast decreased to 69.5 ± 7.5% and then plateaued. Seven patients needed a subsequent session of lipofilling to acquire adequate breast volume and projection. Notably, according to the BREAST-Q back scores, patients who underwent eeLD flap surgery were significantly more satisfied than those who underwent conventional LD musculocutaneous flap surgery using a skin paddle on the back at the same institution (82.8 ± 9.2 versus 62.6 ± 6.3; P < 0.0001). Conclusion: Despite the limitations in volume, eeLD flap plus lipofilling is advantageous because it does not leave a noticeable donor-site scar. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume

Abstract: The thoracodorsal artery perforator via the deep muscular fascial network allows us to harvest a flap of 25 cm × 20 cm with a mean surface of 441 cm² and a mean volume of 193 ml. The extended TDAP flap is a credible option in breast reconstruction.

Cited by 9 publications

References 29 publications

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Thoracodorsal Artery Perforator Flap in Partial Breast Reconstruction: A Systematic Review

Scarless Donor Site for Breast Reconstruction by Endoscopically Assisted Extended Latissimus Dorsi Flap plus Lipofilling

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