Two Options for Perforator Flaps in the Flank Donor Site: Latissimus Dorsi and Thoracodorsal Perforator Flaps

Abstract

Two types of perforators, septocutaneous and musculocutaneous, are found in the same donor site of the flank area, and two perforator flaps based on each perforator are clinically available. Therefore, it is necessary to distinguish them from one another using different nomenclatures. Accordingly, the perforator flap based on a musculocutaneous perforator is named according to the name of the muscle perforated, the latissimus dorsi perforator flap, and the perforator flap based on a septocutaneous perforator, located between the serratus anterior and latissimus dorsi muscles, is named according to the name of the proximal vessel, the thoracodorsal perforator flap. In this series of 42 latissimus dorsi perforator flaps, flap size ranged from 5 x 3 cm to 20 x 15 cm, and two complications were observed: a marginal necrosis in an extremely large flap (26 x 12 cm) and a failure caused by infection. The thoracodorsal perforator flap was used in 14 cases, including two cases of chimeric composition. Flap size ranged from 4.5 x 3.5 to 18 x 15 cm, with no complications. In the two patterns of perforator flap that the author used, initial temporary flap congestion was observed in five latissimus dorsi perforator flap cases and two thoracodorsal perforator flap cases, when the flap was designed as a large flap or a less reliable perforator was selected. However, the congestion was not serious enough to cause flap necrosis. Several techniques, such as T anastomosis or inclusion of an additional perforator or a small portion of muscle, are recommended to prevent the initial flap congestion, especially when an unreliable perforator is inevitably used or when a flap larger than 20 cm long is required. A small portion of the muscle was included in six cases, when an unduly large or improperly long flap was planned. All of the flaps were successful and ranged from 22 x 7 to 15 x 28 cm, except for one case of distal flap necrosis in an extraordinarily large flap measuring 34 x 10 cm. Diverse selection of the perforator flap is one of the great advantages of the flank donor site, providing it with wider availability and more versatile composition for reconstruction or resurfacing.

Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures?

“…At the same time, the plastic surgeon harvested the latissimus dorsi free flap. Flap harvest was performed using the classical method, with all flaps harvested in the supine position without position change . Depending on the condition of the wound, a latissimus dorsi myocutaneous flap was harvested when dead space obliteration was required, or a latissimus dorsi perforator flap was harvested when thin resurfacing was needed.…”

Different Types of Suprafascial Courses in Thoracodorsal Artery Skin Perforators

“…[1][2][3][4][5][6][7][8] It consists of the skin and subcutaneous fat and spares the latissimus dorsi muscle. However, it is too bulky for shallow soft-tissue defects.…”

Toe resurfacing with a thin thoracodorsal artery perforator flap

“…Concomitant forefoot resurfacing can also be performed for patients with severe injuries since flaps up to 20 × 8 cm in size can be harvested safely. When more extensive reconstruction is required, abundant tissue at the lateral thoracic region readily allows chimeric flaps to be created . This can include vascularized ribs for bony reconstruction and multiple skin paddles to correct contiguous defects.…”