Modification of the Elevation Plane and Defatting Technique to Create a Thin Thoracodorsal Artery Perforator Flap

Kim, Kyu Nam; Hong, Joon Pio; Park, Chae Ri; Yoon, Chi Sun

doi:10.1055/s-0035-1563398

Cited by 28 publications

(24 citation statements)

References 9 publications

(21 reference statements)

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“…In 2013, Hong described the superficial fascia as a new plane of elevation for ALT flaps (Hong & Chung, ). Later, he reported the feasibility and efficacy of this technique for gluteal artery (Hong et al, ; Hong et al, ), superficial circumflex femoral artery (Goh, Park, Cho, Choi, & Hong, ; Hong, Choi, et al, ), and thoracodorsal artery perforator free flaps (Kim, Hong, Park, & Yoon, ). This technique allows obtaining thin and reliable flaps, decreasing the need of additional debulking procedures, and improving donor site contour.…”

Section: Introductionmentioning

confidence: 99%

The thin profunda femoral artery perforator flap for tongue reconstruction

et al. 2019

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Background With the ongoing global epidemic of obesity in the Western countries, thigh flaps such as the profunda artery perforator (PAP) free flap, have been less favorable for glossectomy reconstruction due to large bulk of adipose tissue associated with traditional subfascial harvest. In this article, we present a series of 10 patients who underwent reconstruction with suprafascial PAP free flaps following oncologic tongue resection. Methods Our series included six men and four women with an average age of 53.9 years old (range, 28–71 years). All patients underwent preoperative computed tomographic angiography (CTA) for selection of the most suitable perforator and preoperative design of its customized thickness. Flap elevation was performed at the superficial fascia layer while modifying the plane of dissection according to the specific bulk needs in each case. Results Flaps survived in nine patients; one flap failed due to vasospasm. Mean pedicle length was 7.4 cm (range, 6–8 cm). Skin paddle dimensions varied between 8 × 6 and 15 × 9 cm. Flaps thicknesses ranged from 0.4 to 3 cm. Functional outcome was evaluated at 6 months follow up: good speech and deglutition functional outcomes relative to extent of resection were observed. Conclusions The dissection above the superficial fascia layer represents an important refinement to the traditional fasciocutaneous PAP flap. Flap thickness can be tailored to avoid excess of bulk in the medial thigh observed in larger BMI populations.

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Section: Introductionmentioning

confidence: 99%

The thin profunda femoral artery perforator flap for tongue reconstruction

et al. 2019

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“…For coverage of large defects using multi‐lobed flaps, KISS flap and multi‐lobed latissimus dorsi musculocutaneous flap have been reported by Zhang et al (2013) and Zhang, Hayakawa, Levin, Hallock, & Lazzeri (2016)) The latissimus dorsi musculocutaneous flap and the thoracodorsal artery perforator flap are reliable large flaps with reliable vascular pedicles, which can be simultaneously elevated with the patient in a lateral decubitus position (Kim, Hong, Park, & Yoon, 2016). We looked for a flap coverage strategy that can be applied in a prone position with minimal donor site morbidity (with no muscular sacrifice and little or no muscular dissection) and a very reliable anatomy.…”

Section: Discussionmentioning

confidence: 98%

Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk

et al. 2020

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Background The superficial circumflex iliac artery perforator (SCIP) flap cannot be used for coverage of large defects. We introduce a novel flap design to overcome the SCIP flap's size limitation. Methods Data of patients who underwent coverage of defects exceeding 113 cm2 (12 × 12 cm) using combined flaps composed of an SCIP flap and either a superficial inferior epigastric artery (SIEA) flap or a deep inferior epigastric artery perforator (DIEP) flap from September 2015 to September 2019 were retrospectively reviewed. After elevation of the SCIP flap, the SIEA was dissected. If the diameter of the SIEA was smaller than 0.5 mm, a DIEP included in the flap design was identified. For minimal donor site morbidity, the DIEP dissection was limited to its takeoff point from the deep inferior epigastric artery (DIEA), and a small T‐portion of the DIEA was harvested. Results Six patients met inclusion criteria. The average defect size was 18.5 ± 2.3 × 15.7 ± 3.7 cm, and all defects were sufficiently covered. The mean dimensions of the SCIP flap, the SIEA flap, and the DIEP flap were 18.5 ± 2.5 × 7.5 ± 1.0 cm, 15.5 ± 2.1 × 6.6 ± 1.6 cm, and 17.5 ± 2.1 × 6.5 ± 0.7 cm, respectively. All flaps survived completely with no healing complications, and no donor site complications were observed. The SCIP flap was combined with the SIEA flap in four cases and with the DIEP flap in two cases. The average follow‐up period was 12.7 ± 6.7 months. The final outcome was satisfactory in all cases. Conclusion Large defects (up to 20 × 20 cm) can be covered with minimal donor site morbidity, with primary closure, by combining either the SIEA or the DIEP flap with the SCIP flap.

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“…In our series, the TDAP flap reconstruction was our first choice. As the TDAP flap was described, it was mainly applied in breast (Hamdi et al, ) and extremities reconstruction (Kim, Hong, Park, & Yoon, ). Few authors have used this perforator flap in head and neck reconstruction, despite the TDAP flap has all the qualities to be applied in the region (O'Connell et al, ).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series

Scaglioni

Giunta

2018

Microsurgery

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Modification of the Elevation Plane and Defatting Technique to Create a Thin Thoracodorsal Artery Perforator Flap

Abstract: The TDAP flap elevation was modified at the superficial fascia plane, and the defatting technique was used to adjust the flap volume. This technique provided more natural contours and minimized the need for secondary debulking.

Cited by 28 publications

References 9 publications

The thin profunda femoral artery perforator flap for tongue reconstruction

The thin profunda femoral artery perforator flap for tongue reconstruction

Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk

Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series

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