Reconstructing facial contour deformities using stereoscopic thoracodorsal artery perforator adipofascial flaps

Kim, Young Ho; Lee, Kyeong‐Tae; Lim, So-Young; Pyon, Jai-Kyung; Bang, Sa Ik; Oh, Kap Sung; Mun, Goo‐Hyun

doi:10.1002/micr.22462

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…Kim et al also reported uncertainty about the long-term volume loss of the transplanted tissue, when they transferred adipocutaneous tissue nourished by reverse vascular flow from the latissimus dorsi musculocutaneous perforator. 14 We think muscle denervation is also associated with long-term volume reduction.…”

Section: Discussionmentioning

confidence: 97%

Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction

Numajiri

Morita

Tsujiko

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: A transverse paddle latissimus dorsi (LD) flap has the advantage that if the skin paddle is placed in the transverse bra line, the donor site scar is well hidden by underwear. With this transfer, medial back tissues are usually moved to the medial area of the reconstructed breast following 180 degree rotation. Because these tissues are thinner than the lateral thoracic area, the medial part of the reconstructed breast sometimes becomes flatter than expected. Methods: To add bulk in the medial lower quadrant for giving an impression of an outward-expanding breast, we modified the LD flap by adding a part of the trapezius muscle. Seven patients underwent mastectomy and simultaneously received a modified LD flap. To hide the donor site scar beneath underwear, the skin paddle needed to be oriented transversely. The additional harvested tissues were tested for vascularity by fluorescence following intravascular injections of indocyanine green. If this was negative, the tissue was not used for breast reconstruction. Postoperatively, another surgeon judged whether this modification had contributed favorably to the reconstructed medial lower quadrant. Results: Indocyanine green testing was positive in six cases. The shape of the lower medial quadrant was judged as good in five of the seven cases. Complications included an animation deformity of the LD muscle, donor site seroma, and donor site wound dehiscence. Conclusion: This transversely oriented LD flap with extension to the trapezius muscle placed at the bra-line is one option to add bulk to the medial lower quadrant of the reconstructed breast when an additional scar is not desired for cosmetic reasons.

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Section: Discussionmentioning

confidence: 97%

Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction

Numajiri

Morita

Tsujiko

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…At present, the popular and widely used endoscopic technology is effective in reducing incision scars and hiding incisions. In terms of the contour fullness and symmetry of the exposed parts of the body surface, it is particularly important to reconstruct defects after surgery for malignant tumors in the face, neck, or breast 5,6 . The thickness requirements of the flap for reconstruction of different anatomical parts of the head and neck vary greatly to a certain extent.…”

Section: Discussionmentioning

confidence: 99%

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

Yang,

2024

Ann Plast Surg

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Background and Objective Patients with local advanced hypopharyngeal combined with esophageal cancer often require total laryngectomy and cervical esophagectomy, which result in big-sized upper aerodigestive tract defects and neck deformities. Although free flap is widely used to reconstruct aerodigestive defects, the aesthetic results especially that of neck contour have not brought to the forefront or discussed extensively. This article aims to report the preliminary aesthetic results of free flap reconstruction for local advanced hypopharyngeal cancer combined with cervical esophageal cancer defects, highlighting the thickness of subcutaneous fat of the flap. Methods A retrospective study of 21 patients with local advanced hypopharyngeal combined with cervical esophageal cancer from July 2010 to August 2022 was conducted. After completing total laryngectomy, bilateral neck dissection, and removal of the tumor with safe margin, a free thigh flap of subcutaneous fat greater than 1 cm in thickness was used to reconstruct the hypopharyngeal and cervical esophageal defects. In addition to general demographic, oncological, and reconstructive data, preoperative and postoperative neck circumferences were recorded and compared. A subjective questionnaire survey was conducted on patients' satisfaction with postoperative neck contour. The patients were followed up from 3 to 10 years, with an average of 3 years. Results There were 2 cases (2/21) of free flap loss because of flap necrosis and secondary repair with a pedicled pectoralis major flap. Nineteen flaps (19/21) survived. Three cases (3/21) developed a pharyngeal fistula and one case (1/21) experienced salivary fistula, all of the fistulae healed after drainage and dressing change. There was a relatively high satisfaction rate among patients (16/21) with the postoperative neck contour. A paired sample t test showed no statistically significant difference between the preoperative and postoperative values (t = 2.002, P > 0.05). Patients with a thicker subcutaneous fat flap (≥1.5 cm) had a more symmetrical and fuller neck contour during long-term postoperative follow-up. Conclusions The application of a fat-rich subcutaneous free thigh flap to reconstruct the defect of local advanced hypopharyngeal combined with cervical esophageal cancer can achieve better neck aesthetic contour.

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“…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, ). The TDAP is a thin and pliable flap, with a long pedicle usually spared from atherosclerotic changes (Kim et al, ; O'Connell et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The thoracodorsal artery perforator flap (TDAP) described by Angrigiani, Grilli, & Siebert (), based on perforators arising from the thoracodorsal artery, consists on the overlying skin and subcutaneous tissue but not on the underlying LD muscle. Despite these advantages, the TDAP flap is not yet widely used in the head and neck reconstruction (Chao, Yu, Skoracki, Demonte, & Hanasono, ; Guerra, Lyons, Dupin, & Metzinger, ; Kim et al, ; Lee & Mun, ; O'Connell, Bajwa, Schache, & Shaw, ; Sosin, De la Cruz, et al, ).…”

Section: Introductionmentioning

confidence: 99%

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

Scaglioni

Giunta

2018

Microsurgery

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Reconstructing facial contour deformities using stereoscopic thoracodorsal artery perforator adipofascial flaps

Abstract: Our results suggest that the stereoscopic TDAP adipofascial flaps with diligent secondary approaches may be a reliable alternative for aesthetic reconstruction of facial contour deformities. © 2015 Wiley Periodicals, Inc. Microsurgery 37:300-306, 2017.

Cited by 7 publications

References 34 publications

Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction

Extension toward the Trapezius in a Transversely Oriented Latissimus Dorsi Flap for Breast Reconstruction

Aesthetic Considerations of Simultaneous Reconstruction With Free Flap for Local Advanced Hypopharyngeal Combined With Cervical Esophageal Cancer

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

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