The Thoracodorsal Artery Perforator Flap: Anatomic Basis and Clinical Application

Abstract

Based on the dissection of 20 fresh cadavers, the authors have detailed further the vascular anatomy of the thoracodorsal artery and its cutaneous perforator vessels. The thoracodorsal artery showed a constant bifurcation into a horizontal branch and a lateral branch, located on the deep surface of the latissimus dorsi muscle 4 cm (range, 3-6 cm) distal to the inferior scapular border and 2.5 cm (range, 1-4 cm) medial to the lateral free margin of the muscle. In 20 specimens there was a total of 64 musculocutaneous perforators larger than 0.5 mm. Thirty-six perforators (56%) originated from the lateral branch and 28 perforators (44%) originated from the horizontal branch. All perforators originated within a distance of 8 cm from the neurovascular hilus and ran in proximity with the horizontal or lateral branches. In 11 dissections (55%) there was also a direct cutaneous branch originating from the extramuscular course of the thoracodorsal artery before the neurovascular hilus. This cutaneous branch did not pierce the latissimus muscle but rounded the lateral muscle edge and supplied the overlying subcutaneous tissue and skin. It is hoped that the constant anatomy will encourage surgeons in the future to use the thoracodorsal artery perforator flap more often.

Surgical Technique in Pedicled Thoracodorsal Artery Perforator Flaps: A Clinical Experience with 99 Patients

“…At this point, the first perforator emerges from the descending branch of the thoracodorsal pedicle and usually travels above the deep fascia caudally and parallel to the latissimus dorsi muscle fibers. The scapular tip was used by Heitmann et al 5 to locate the bifurcation of the thoracodorsal vessel into its respective hori- …”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Although the thoracodorsal artery perforator flap has been reportedly used in multiple reconstructive situations, it has not gained the popularity of other perforator flaps such as the deep inferior epigastric artery perforator flap. Reasons for this include inconsistent perforator size, quality, quantity, and location, all of which contribute to tedious dissection.…”

“…4,11,12 Thus, only small clinical series of thoracodorsal artery perforator flaps have been published. [1][2][3][4][5][6][7][8][9][10][11][12] The thoracodorsal artery perforator flap has been used widely in our department as either a free 9 or a pedicled flap. 6 The purpose of this article is to report our clinical experience with a large series of pedicled thoracodorsal artery perforator flaps used for a variety of indications, with an emphasis on preoperative planning, safe and standardized dissection technique, and an analysis of major and minor postoperative complications.…”

Perforator Flaps: Principles and Techniques

“…According to the cadaveric dissections of Heitmann et al investigating the anatomical basis of thoracodorsal artery perforator flaps, out of 20 specimens, a total of 64 musculocutaneous perforators larger than 0.5 mm were found [30]. In total, 36 of these perforators were arising from the descending branch whereas 28 were arising from the transverse branch [30]. However, in 11 dissections, there was also a direct cutaneous branch with an extravascular course [30].…”

“…This artery is a branch of the subscapular system and divides into transverse and descending branches after entering to the latissimus dorsi muscle. According to the cadaveric dissections of Heitmann et al investigating the anatomical basis of thoracodorsal artery perforator flaps, out of 20 specimens, a total of 64 musculocutaneous perforators larger than 0.5 mm were found [30]. In total, 36 of these perforators were arising from the descending branch whereas 28 were arising from the transverse branch [30].…”