One-Stage Transfer of 2 Paddles of Thoracodorsal Artery Perforator Flap With 1 Pair of Vascular Anastomoses for Barraquer-Simons Syndrome

Abstract

We report a novel technique: a 1-stage transfer of 2 paddles of thoracodorsal artery perforator (TAP) flap with 1 pair of vascular anastomoses for simultaneous restoration of bilateral facial atrophy. A 47-year-old woman with a severe bilateral lipodystrophy of the face (Barraquer-Simons syndrome) was surgically treated using this procedure. Sufficient blood supply to each of the 2 flaps was confirmed with fluorescent angiography using the red-excited indocyanine green method. A good appearance was obtained, and the patient was satisfied with the result. Our procedure has advantages over conventional methods in that bilateral facial atrophy can be augmented simultaneously with only 1 donor site. Furthermore, our procedure requires only 1 pair of vascular anastomoses and the horizontal branch of the thoracodorsal nerve can be spared. To our knowledge, this procedure has not been reported to date. We consider that 2 paddles of TAP flap are safely elevated if the distal flap is designed on the descending branch, and this technique is useful for the reconstruction of bilateral facial atrophy or deformity.

Chimeric Latissimus Dorsi Flap in One-Stage Reconstruction of Depressor Muscle Dysfunction and Depression Deformity in the Perimandibular Area

“…We often use LD flaps for secondary reconstruction after head and neck surgery 19–11,13 . They are versatile and can augment extensive depression and smile reanimation because they can be divided into components with a single vascular pedicle by branching of the thoracodorsal vessel and nerves.…”

Quantitative Evaluation of Blood Perfusion to Nerves Included in the Anterolateral Thigh Flap using Indocyanine Green Fluorescence Angiography: A Different Contrast Pattern between the Vastus Lateralis Motor Nerve and Femoral Cutaneous Nerve

“…In this study, ICG fluorescent angiographic images confirmed the perfusion of nerves in ALT flaps. We previously used ICG fluorescence angiography to monitor blood flow 14,15 because it allows clear and safe visualization of blood flow and is minimally invasive, cheap, and easy to prepare. Adverse reactions to the infusion of ICG (e.g., nausea or anaphylactic shock) are potential risks, but their incidence is very low (less than 0.1%).…”

Intraoperative salvaging of failure to harvest the bi-paddle anterolateral thigh flap: a case series

“…Moreover, turning the length to width of the bi-paddle flap enables primary closure of the donor site. There are several reports regarding the clinical application of the bi-paddle flap, such as the bi-paddle radial artery flap (6), the double skin paddle ALT flap (7,8) and the bi-paddle thoracodorsal artery flap (9). It provides bespoke cover for large soft-tissue defects with improved morbidity and cosmesis of the donor site; more tissue can be harvested because of the multiple perforators (8).…”