The Vascular Basis of the Thoracodorsal Artery Perforator Flap

Abstract

The thoracodorsal artery perforator flap is a reliable cutaneous perforator flap that is very useful in a wide variety of clinical applications.

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

“…Partial flap necrosis occurs if the flap is extended beyond it vascular territory, estimated at 255 cm by Thomas et al 15 In comparing our experience with a vertical flap design (used mainly in microvascular transfer) and a more horizontal flap orientation (used mainly in pedicled flaps), we have observed a slightly higher rate of partial necrosis, typically in the distal tip, in the vertical design. This is likely related to the orientation of the angiosome territory of the thoracodorsal perforators.…”

“…3,7,15,16 Recent studies demonstrate only 5.5 Ϯ 1.8 perforators with a diameter greater than 0.5 mm supplying this flap. 15 However, only one or two perforators can be clinically used if a useful arc of rotation is to be maintained. Multiple cadaveric dissection studies have focused on determining the relationship between topographic landmarks and the thoracodorsal perforators.…”

“…Multiple cadaveric dissection studies have focused on determining the relationship between topographic landmarks and the thoracodorsal perforators. 2,8,15 Since the original description of Volume 121, Number 5 • Thoracodorsal Artery Perforator Flap the thoracodorsal artery perforator flap by Angrigiani et al, 1 the location of the majority of perforators 8 cm distal to the posterior axillary fold remains a valid and important anatomical landmark. 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.…”

“…With an average length of 14 Ϯ 1.4 cm, the flap can reach more medial defects on the chest wall than the scapular/ parascapular flap. 8,15 When the thoracodorsal artery perforator flap is based on a distal perforator, pedicle length can reach 25 cm, 8 providing a broad arc of rotation extending over the anterior chest wall, clavicle, axilla, posterior arm, and lateral border of the sternum. Tension on the pedicle must be avoided, as this may lead to rupture of smaller perforators.…”

Mastopexy With Autologous Augmentation After Massive Weight Loss

“…11 Additional anatomic study and surgical dissection elucidated topographic reference points for locating the perforating vessels 12 and increased the dimensions that could be harvested to broaden the clinical applications of the thoracodorsal artery perforator flap. 13,14 In 2002, Holmstrom and Lossing 15 identified the contribution of the intercostal perforators along the submammary crease in the lateral thoracodorsal flap. In MWL patients, the lateral thoracic area frequently demonstrates redundant skin and subcutaneous tissue, with significant generalized ptosis.…”