Sensate Thoracodorsal Artery Perforator Flap: A Focus on Its Preoperative Design and Harvesting Technique

Lin, Cheng Ta; Yang, Kuo Chung; Hsu, Kuei‐Chang; Liu, Wen‐Chung; Chen, Jin Shyr; Chen, Lee Wei

doi:10.1097/prs.0b013e3181909c34

Cited by 23 publications

(16 citation statements)

References 25 publications

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“…5,7,13 The route of intercostal artery indicates the course of intercostal nerve based on their concomitant relation. The details of operating color Doppler scanning to locate the thoracodorsal artery perforators and the lateral cutaneous branches of intercostal arteries were described.…”

Section: Preoperative Imaging Surveymentioning

confidence: 99%

“…9,11,13 Based on the intraoperative findings, the anatomic relations between the thoracodorsal artery perforators and the neighboring intercostal nerves are classified into 3 types (Fig. 9,11,13 Based on the intraoperative findings, the anatomic relations between the thoracodorsal artery perforators and the neighboring intercostal nerves are classified into 3 types (Fig.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…The first is using a flap with less donor site morbidity. 11,13 Even though the flap exhibits many advantages, some limitations may hinder its use in the reconstruction of fingers. The third is giving sensory recovery to improve the long-term functional recovery.…”

mentioning

confidence: 99%

“…The second is offering pliable and glabrous soft tissue coverage to provide gliding of tendons and thin contour. 13 Second, the thinning procedure, which removes most subcutaneous adipose tissue, is developed to deal with the flap bulkiness. In the various reconstructive methods to resurface complicated finger defects, the free flaps are often used nowadays because of the advancement in microsurgery.…”

mentioning

confidence: 99%

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Surgical Refinements and Sensory Recovery of Using Transverse Sensate Thoracodorsal Artery Perforator Flaps to Resurface Ring-Avulsed Fingers

Lin¹,

Chen²

2014

Annals of Plastic Surgery

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To improve the use of thoracodorsal artery perforator flaps in resurfacing ring-avulsed fingers, the relations between the thoracodorsal artery perforators and intercostal nerves were investigated. The surgical refinements, clinical results, and sensory recovery of flaps were presented. Eleven patients with ring-avulsed fingers were reviewed. Separated and conjoint relations were found. Eleven flaps were harvested with 3 refinements. First is the transverse flap design. Second is operating color Doppler sonography to identify the relations. Third is using the conjoint relation to facilitate adequate flap thinning. Four patients had separated relation, and 7 patients had conjoint relation. Only 1 patient showed flap tip necrosis. Two patients with separated relation needed flap debulking. Ten patients acquired protective to normal tactile sensation, and 9 patients gained fair to normal discriminative sensation. The free transverse sensate thoracodorsal artery perforator flaps can be an option in the reconstruction of ring-avulsed fingers.

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Section: Preoperative Imaging Surveymentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Surgical Refinements and Sensory Recovery of Using Transverse Sensate Thoracodorsal Artery Perforator Flaps to Resurface Ring-Avulsed Fingers

Lin¹,

Chen²

2014

Annals of Plastic Surgery

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“…The perforator supplying the skin is marked pre-operatively using colour doppler sonography and even sensate flaps have been described using posterior divisions of the lateral cutaneous branches of the intercostal nerves harvested with the flaps. 32 The perforator is dissected out and harvested with the thoracodorsal artery and used as a free flap for head and neck reconstruction. Thoracodorsal artery perforator flap has a reliable blood supply and can be made as large as 10 cm × 25 cm.…”

Section: Thoracodorsal Artery Perforator Flapmentioning

confidence: 99%

Novel flaps for head and neck reconstruction

Ahmad

Shankhdhar

2010

Indian J Surg Oncol

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The head and neck region is important both functionally and aesthetically and its reconstruction poses a formidable challenge for plastic surgeons. A perforator flap is a flap of skin or subcutaneous tissue supplied by a vessel that perforates the deep fascia to gain access to flap. With improvement in our knowledge of the anatomy of blood supply to the skin, the perforator flaps have opened a whole new horizon for the plastic surgeon to choose flaps with better function and cosmesis. The locally available perforators enable flaps to be designed with excellent match in tissue characteristics. Perforator flaps limit donor site morbidity and as they are islanded complete insetting is possible in a single stage. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supra-clavicular artery flap used in the head and neck reconstruction are discussed. The more commonly used flaps are the free radial artery forearm flap and the anterolateral thigh flap while the novel ones are the thoracodorsal artery perforator flap, medial sural artery perforator flap and the toe-web flap for commissure reconstruction. The indications, reach and drawbacks of these flaps have been discussed in this review.

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The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap

Ensat

Babl

et al. 2012

Microsurgery

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The anterolateral thigh (ALT) flap has become a workhorse in reconstructive surgery of the head and neck region and the extremities. However, its inconsistent vascular anatomy and frequent intramuscular course of perforators often cause difficulties during the dissection of this versatile flap. Hence, reliable preoperative perforator mapping and identification of vascular anomalies may render the raising of the flap easier and safer. The aim of this study was to evaluate the use of Color Duplex sonography and whether it allows the distinction between septocutaneous and musculocutaneous perforators. For this purpose, the thighs of 13 patients undergoing reconstruction with ALT flaps were examined preoperatively, and results were compared to intraoperative findings. A total of 30 perforators could be detected preoperatively, of which 29 were confirmed during flap dissection. Preoperative Color Duplex sonography correctly predicted the course of all perforators as either running through the vastus lateralis muscle or the intermuscular septum. In our investigations, Color Doppler sonography had a 96.7% positive predictive value and a 96.7% true positive rate in detecting perforators. Color Duplex sonography is a highly reliable tool in the preoperative assessment of ALT flaps. Localization and course of perforators can be determined accurately and vascular anomalies can be identified.

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Sensate Thoracodorsal Artery Perforator Flap: A Focus on Its Preoperative Design and Harvesting Technique

Cited by 23 publications

References 25 publications

Surgical Refinements and Sensory Recovery of Using Transverse Sensate Thoracodorsal Artery Perforator Flaps to Resurface Ring-Avulsed Fingers

Surgical Refinements and Sensory Recovery of Using Transverse Sensate Thoracodorsal Artery Perforator Flaps to Resurface Ring-Avulsed Fingers

Novel flaps for head and neck reconstruction

The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap

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