We, hereby, describe its versatility in indications freepedicled, methods of harvest patient position and paddle orientation and perforator consistency. Anatomy posterior intercostal bundle the anatomy and course of the intercostal vessels have been thoroughly studied in the anatomical. The optimal reconstruction method should provide thin, and wellvascularized tissue with minimal donorsite morbidity. The thoracodorsal artery perforator flap request pdf. Nowadays, pedicle perforator flaps have been described for partial breast mastectomy reconstruction the study comprised all patients who received partial breast resection due to external quadrant breast cancers and who were reconstructed with thoracodorsal perforator flap between august 2010 and. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. Extended thoracodorsal artery perforator flap for breast reconstruction. This flap presents good quality texture and has a similar color to the axillary region. Thoracodorsal artery perforator flap and latissimus dorsi. Use of the thoracodorsal artery perforator tdap flap with.
Erratum to propeller thoracodorsal artery perforator flap for breast reconstruction in the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors. The donor site can usually be closed, and the scar is not objectionable. The thoracodorsal artery perforator tdap flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. Thoracodorsal artery perforator tdap flap plastic surgery key. It can be treated with several surgical approaches.
Surgical anatomy of the medial sural artery perforator flap wong et al. Superficial circumflex iliac artery perforator scip flap presenter. The pattern of the thoracodorsal artery in the latissimus dorsi muscle the present study showed that of all the 60 dissections made, the thoracodorsal artery divided into a medial and a lateral branch, and ran on the deep surface of the muscle. Propeller thoracodorsal artery perforator flap for breast. This flap requires intramuscular dissection of the pedicle. For example, when a large thoracodorsal artery perforator flap is planned, it must be planned over the latissimus dorsi muscle to incorporate neighboring. Propeller thoracodorsal artery perforator flap for breast reconstruction article pdf available july 2014 with 115 reads how we measure reads. The usefulness of pedicled perforator flap in partial breast. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts.
Recently, surgeons have begun to combine implantbased reconstruction with flaps that sacrifice less ld muscle. Pdf extended thoracodorsal artery perforator flap for. The thoracodorsal artery perforator tdap flap is based on the branches of the thoracodorsal artery as they pass through the latissimus dorsi to perfuse the overlying soft tissue. The proximal perforator pierces the muscle and enters the subcutaneous tissue approximately 8 cm below the posterior axillary fold and 23 cm posterior to the lateral border of the muscle. The detailed surgical technique with its variations is. A total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. It has been championed as an alternative to the tug flap.
Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise. Surgical anatomy of the medial sural artery perforator flap. Thoracodorsal artery perforator flap tap flap microsurgeon. However, there are few reports about the role of this flap in total. It is hoped that the constant anatomy will encourage surgeons in the future to use the thoracodorsal artery perforator flap more often. Versatility of the pedicled thoracodorsal artery perforator. The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa.
Oct 14, 2012 oncoplastic approach to reconstruct partial breast resection is always challenging. Profunda artery perforator pap flap from the back upper thigh. A cutaneous nerve may be seen accompanying the largest perforator. An assessment of the anatomical basis of the thoracoacromial. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breast s.
Tdap flap is as reliable a technique as ld flap regarding the feasibility. The latissimus dorsi ld musculocutaneous flap with implant has been widely used for breast reconstruction. This flap was originally described in 1995 as a method for. This technique, which is safe and reliable, results in the sacrifice of the largest muscle in the body with high seroma incidence in the donor site. Three and fourdimensional arterial and venous anatomies. The versatile clinical use of the intercostal artery perforator. The thoracodorsal artery perforator tdap flap spares the ld muscle. Thoracodorsal artery perforator flap as an autologous. Our group first described the thoracodorsal artery perforator flap tdap in 1995, in an attempt to minimize donorsite complications related to the latissimus dorsi muscle cutaneous flap. Figure 6 a a 22yearold male presented with a left foot degloving injury with. Haq eu, javaid rh, hameed s, saood r, majid a, waqas m, aslam a, yusuf o background.
Women with unfavorable defects will often benefit from volume replacement technique, such as pedicled perforator flaps. However, searching for a reliable perforator and the tedious process of intramuscular retrograde dissection of the perforator are timeconsuming and skilldemanding. Thoracodorsal artery perforator flap dissected and deepithelialized b. The thoracodorsal artery perforator tdap flap is a versatile tool in reconstructive surgery and its use in breast reconstruction is becoming increasingly popular. Pectus excavatum is a common congenital deformity involving the anterior thoracic wall. Basic surgical determinants find, read and cite all the research you need on researchgate. The lateral upper arm flap is supplied by septocutaneous branches of the posterior radial collateral artery prca, which develops from the profunda brachii artery.
The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. Since then, several studies have demonstrated that the use of musclesparing latissimus dorsiflap is feasible and ensures excellent objective and subjective aesthetic outcomes without contour. From the bifurcation of thoracodorsal artery at least one perforator was found from 5 to 10 cm, within 4. The flap vascularization is supplied by the skin perforator of the lateral superior genicular artery lsga, the right branch of the popliteal artery 11,14. Pdf propeller thoracodorsal artery perforator flap for. A total of 45 patients underwent partial or total autologous breast reconstruction after skin sparing mastectomy, skinreducing. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. Extended thoracodorsal artery perforator flap for breast reconstruction a total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. Download as an information leaflet pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. Thoracodorsal artery perforator flap for partial breast. Furthermore, we could not thoracodorsal artery perforator flap 393 figure 4a after numerous attempts at noma defect reconstruction, scar contracture and problems with lip closure remain. Pdf propeller thoracodorsal artery perforator flap for breast. A perforator or combination of perforators off the distal main thoracodorsal andor its lateral branch constitute the vascular supply of the tap flap. Extended thoracodorsal artery perforator flap for breast.
Thoracodorsal artery perforator flap for reconstruction. Lateral thigh perforator ltp flap from the outer thigh. These flaps include the musclesparing latissimus dorsi msld flaps that were described by hamdi et al 9 in 2004 and the thoracodorsal artery perforator tdap flap that was first described by angrigiani et al 10 in 1995. It is a composite flap and comprises muscle, overlying fascia and skin.
The skin paddle can be from 18 cm wide and up to 55 cm long can be harvested on a single perforator. B appearance 14 months after tissue augmentation with a tap flap, resulting in significant aesthetic and fnnctional improvement. The thoracodorsal artery perforator tdap flap has emerged as one of the ideal perforator flaps. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction.
In the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction was published with some errors the legends of preoperative a marks. Thoracodorsal artery perforator flap and latissimus dorsi myocutaneous flap anatomical study of the constant skin paddle perforator locations. Thoracodorsal artery perforator fasciocutaneous flap. It yields a relatively long, thin and pliable skin flap and a. Its role in partial breast reconstruction has been well documented. Dissection of 20 fresh cadavers disclosed a constant bifurcation of the thoracodorsal artery into a horizontal and lateral branch on the. The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators.
However, this could be overcome by training and experience 11. This artery is found within a triangle limited anteriorly by the vastus lateralis muscle. Breast reconstruction, bilateral, thoracodorsal artery perforator flap tap. Apr 02, 2016 the lateral upper arm flap is supplied by septocutaneous branches of the posterior radial collateral artery prca, which develops from the profunda brachii artery. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic devices has been proven to be a safe method of breast reconstruction. This flap is the equivalent of the latissimus myocutaneous flap without the inclusion of the musculature of the latissimus. Jun 26, 2016 thoracodorsal artery perforator tdap flap c. Thoracodorsal artery perforator tdap or tap flap from the back this is the. The objective of this study was to document the vascular anatomy of this.
Use of thoracodorsal artery perforator flaps to enhance. Journal of plastic, reconstructive and aesthetic surgery. Thoracodorsal artery perforator tdap flap in immediate. The tap flap is nourished by perforators of the descending branch of the thoracodorsal artery. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels.
We have used the thoracodorsal artery perforator flap to reconstruct. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires breast plastic and reconstructive surgeons at johns hopkins medicine also. Three and fourdimensional arterial and venous anatomies of. Pdf on jan 1, 2012, celalettin sever and others published thoracodorsal artery perforator flap. The flap was transposed onto the breast anterolateral and posterolateral chest wall. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. Use of the thoracodorsal artery perforator tdap flap in combination with alloplastic devices has been proven to be a safe method of breast.
Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper. The versatility of the intercostal artery perforator. The thoracodorsal artery perforator tdap flap has been described for breast reconstruction. Visualized bilateral breast reconstruction by propeller thoracodorsal. A sensate lateral sural artery muscle perforator flap. In one specimen, this perforator was located more distally, 15 cm from the popliteal crease. Tap flap breast reconstruction and share our results using this technique. The choice of reconstruction technique is therefore crucial, along with the need for extensive. It is a flap that should be used more frequently than it is. Medial sural artery perforator free flap msap british. This video demonstrates the propellar flap based on the perforators of posterior tibial artery for medial malleolar defect.
Thoracodorsal fasciocutaneous flap in the treatment of. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Use of the thoracodorsal artery perforator tdap flap. Sep 1996 kamran khoobehi, md, robert allen, md, and walton j. The tap flap is based on one of the two to three cutaneous perforators off the vertical thoracodorsal artery. A second perforator wasfoundinthe medial row at 10 cm distal to the popliteal crease. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. A second perforator that appears to be in the same longitudinal plane as the first can also be dissected free and used to further nourish the flap not pictured. Lateral flap of the thigh based upon the lateral superior.
The thoracodorsal artery perforator scapular osteocutaneous tdap soc flap for reconstruction of palatal and maxillary defects. The dominant perforator is traced through the muscle to the descending branch of the thoracodorsal artery. Dissection of 20 fresh cadavers disclosed a constant bifurcation of the thoracodorsal artery into a horizontal and lateral branch on the deep surface of the latissimus dorsi muscle. Erratum to propeller thoracodorsal artery perforator flap for.
Pdf extended thoracodorsal artery perforator flap for breast. Thoracodorsal artery perforator tdap flap is one of the relatively new techniques in breast reconstruction. The medial sural artery muscle perforator flap would be called the msap flap using the canadian terminology 9, or the ms medial gastrocnemius muscle perforator flap if one prefers to include both the source vessel and the muscle intermediary as part of the nomenclature 10. To our best of knowledge, this is the first case of pectus excavatum repair via a 2stage double thoracodorsal artery perforator flap procedure in a 37yearold patient. Oncoplastic approach to reconstruct partial breast resection is always challenging. Surgeons who perform perforator flap reconstruction. Thoracodorsal artery perforator flap tap is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. The pap flap for breast reconstruction was originated in 2010 by dr.
Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix tarek hashem1,2 and ahmed farahat1 abstract background. Paraumbilical perforator pup flap is essentially the same as a diep or siea flap, but uses a perforator artery that is closer to the navel. Use of thoracodorsal artery perforator flaps to enhance outcomes. Jun 22, 20 anatomy of the latissimus dorsi muscle everything you need to know dr. The anatomy of the thoracodorsal artery in perforator flap. Rotational thoracodorsal fasciocutaneous flap is a practical and reliable technique that can be applied locally for regional cover. In none of our cases was the latissimus dorsi muscle included. Angrigiani editorial comment this is a reasonably reliable flap, with consistent anatomy.
Dec 06, 2017 erratum to propeller thoracodorsal artery perforator flap for breast reconstruction in the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors. The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three and fourdimensional computed tomographic angiography and venography. The thoracodorsal artery perforator tdap flap is a fasciocutaneous flap that. Cosmetic outcomes were measured by combining selfreported patient satisfaction.
The perforators of the flap run within the lateral intermuscular septum, which separates the brachialis from the triceps muscle fig. Profunda artery perforator pap flap for breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Above, left the arc of rotation for the thoracodorsal artery perforator flap. A modification of the conventional tdap surgical technique for breast reconstruction is described, utilizing instead a propeller tdap flap. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Thoracodorsal artery perforator flap for reconstruction department of plastic surgery, louisiana state university medical center, new orleans. Postoperative anterior view c shows optimal evolution of the cutaneous flap island. Use of thoracodorsal artery perforator flaps to enhance outc. Erratum to propeller thoracodorsal artery perforator flap.