Thoracodorsal Artery Perforator Flap: A Versatile Alternative for Various Soft Tissue Defects

Abstract

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

“…The widespread use of the thoracodorsal artery perforator flap is attributable to the following characteristics: basically reliable anatomy, the ability to thin the flap without compromising its blood supply, the possibility of obtaining a long pedicle, the pliability of the flap, the potential of preparing a chimeric flap on the subscapular vascular system, and the lack of significant donor-site morbidity. [12][13][14][15][16][17][18][19][20][21][22] There have been some articles published regarding the use of the pedicled thoracodorsal artery perforator flap for burn reconstruction in the upper extremity. It was revealed that the pedicled thoracodorsal artery perforator flap is a suitable option for the reconstruction of axillary burn contractures.…”

“…Over the past few years, free or pedicled transfers of this flap have been used for various reasons. [11][12][13][14][15][16][17][18][19][20][21] This flap has been used as a pedicled flap for reconstruction of regional defects on areas such as the trunk, axilla, and breast, or as a free flap in the reconstruction of various defects in areas such as the skull base, face, elbow, forearm, and lower extremity. There is no literature, however, regarding the use of the pedicled thoracodorsal artery perforator flap for reconstruction of soft-tissue defects in the antebrachial region after postburn contracture release.…”

Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review

“…The thoracodorsal perforator artery flap advantages lie in its long pedicle, homogeneous flap thinness, its muscle preserving properties, minimal donor morbidity, and a relatively large stock of soft tissue. 19,31,60,61 We advocate for musclesparing adipocutaneous free tissue transfer to prevent longterm atrophy as seen in case 7 with the muscle-only latissimus dorsi (►Figs. [9][10][11].…”

Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects

“…In addition, the TDAP flap offers distinct advantages, including a large flap dimension, a long pedicle length and excellent contour restoration. [6][7][8]17] Soft tissue defects on the lower and upper extremity require thin flaps, and patients who have relatively thin back tissue with the pinch test are ideal candidates for TDAP flap reconstruction. [17] The defects of shoulder and axilla have the same soft tissue properties like the donor site and TDAP flap provides good coverage when transferred pedicled to these areas.…”