Inclusion of extra perforators – A single and efficient measure to prevent vascular insufficiency in unreliable thoracodorsal artery perforator flaps

Lin, Cheng Ta; Chen, Lee Wei

doi:10.1016/j.bjps.2011.09.017

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…In this case, patient selection failed; the patient had received neoadjuvant chemotherapy and radiation therapy due to an inflammatory breast cancer and the tissue was severely damaged by cancer and the neoadjuvant therapy. Primary breast reconstruction should not have been initiated, and this confirms the importance of patient selection [5]. The other patient with major complications was our only double TAP flap.…”

Section: Discussionsupporting

confidence: 52%

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Propeller TAP flap: Is it usable for breast reconstruction?

Thomsen

Bille

Wamberg

et al. 2013

Journal of Plastic Surgery and Hand Surgery

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The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around the perforator to ensure a sufficient venous return.

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Section: Discussionsupporting

confidence: 52%

“…Colour Doppler ultrasonography was performed in all cases by the surgeon before the operation, to ensure the presence of a good perforator. Inclusion of patients with sufficient perforators has been shown to be of importance to prevent unreliable TAP flaps [5,6].…”

Section: Discussionmentioning

confidence: 99%

Propeller TAP flap: Is it usable for breast reconstruction?

Thomsen

Bille

Wamberg

et al. 2013

Journal of Plastic Surgery and Hand Surgery

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“…[ 17 ] Moreover, there is evidence that it is efficient to prevent vascular insufficiency of unreliable flaps by including extra perforators. [ 18 ] These results indicate that increased number of perforators could be included in the pedicle to improve blood supply. Location of the vascular pedicle of the flap is readjusted according to the form of the flap and the vessel anatomy of the anterolateral thigh region.…”

Section: Discussionmentioning

confidence: 99%

Microdissected thin anterolateral thigh perforator flaps with multiple perforators

Liang

Liu²,

Qiu³

et al. 2018

Medicine

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Introduction:The study aimed to explore the effect of microdissected thin anterolateral thigh (MTALT) perforator flap with multiple perforators on patients with complex defects on the hand, elbow, heel, or knee.Methods:From March 2012 to February 2013, 5 patients with complex defects on the hand, elbow, heel, or knee were included. During the flap preparation, 2 to 3 perforators penetrating the fascia of the anterolateral femoral area were initially detected, and the deep fascia was incised. The superficial fascia layer of the flap and the deep adipose were then dissected, and removed after verifying the distribution of the blood vessels using an operating microscope. The whole flap was then elevated, and transposed to the recipient areas for microsurgical reparation.Results:Two cases of post-burn scar contracture and 3 cases of traumatic tissue defects were successfully reconstructed with these multiple-perforator MTALT flaps. No complication was reported, and secondary operative procedure was not needed in any patient in the follow-up.Conclusion:MTALT perforator flap with multiple perforators is safe and reliable for patients with complex defects on the hand, elbow, heel, or knee.

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“…In addition, a long vascular pedicle has been found to serve as a bypass around the injured zone in the reconstruction of traumatic defects. 23 There is no scientific evidence regarding T-anastomosis and its influence in decreasing arterial inflow to prevent venous congestion. 23,24 However, there is no standard method available to improve perforator flap viability.…”

Section: Discussionmentioning

confidence: 99%

“…23 There is no scientific evidence regarding T-anastomosis and its influence in decreasing arterial inflow to prevent venous congestion. 23,24 However, there is no standard method available to improve perforator flap viability. Our flap design can be a useful research tool to establish objective criteria to help define optimal flap design, thickness, width-length ratio, and length of vascular pedicle and to judge whether or not T-anastomosis and the muscle-sparing technique are necessary.…”

Section: Discussionmentioning

confidence: 99%