Use of pectoralis major perforators for local “free‐style” perforator flap in axillary reconstruction: A case report

Abstract

Axillary scar contracture in a previously poly-traumatized present a challenging task for a reconstructive surgeon from the functional and esthetic standpoint. While harvest of local myocutaneous flaps will obviously contribute to further limitation of arm movements in already functionally impaired shoulder, pedicled perforator flaps from the lateral and posterior thoracic region may not be available due to extensive scarring after high-energy trauma with soft-tissue loss. We present a new perforator pedicled flap, designed, and harvested exclusively on the basis of "free style perforator flap" concept, based on the perforators coming from the pectoral region. The operative technique and outcome are discussed in this report.

Thoracoacromial artery perforator flap based on the clavicular branch: A new option in regional reconstruction

“…The TAAP flap has been used only in a few select clinical cases, such as in axillary, head, and neck reconstruction, because of the variability of the vascular anatomy. However, Zhang et al ., recently discussed the case reported by Kosutic, who had h an axillary scar contracture, which was reconstructed using a ‘free‐style’ perforator flap based on pectoralis major perforators, and stated that the mentioned perforators might have originated from the lateral thoracic artery. They also proposed that more consistent perforators might be detected in a limited area around the point of intersection of a line from the acromion to xyphoid process, with a line from midpoint of the clavicle perpendicular to the former one.…”

“…There are few reports on the clinical use of the thoracoacromial artery perforator (TAAP) flap. Reconstructions of the head and neck and axillary regions with TAAP flaps have been previously described …”

“…Although the pectoralis major flap remains a ‘workhorse’ flap, some authors consider it a ‘salvage flap’ for head and neck reconstruction, because of the advances in microsurgery and free tissue transfer. Consequently, the pectoralis major flap is used mainly for chest wall and upper arm reconstruction . In contrast, there are few reports on the clinical use of the TAAP flap.…”

“…Reconstructions of the head and neck and axillary regions with TAAP flaps have been previously described. 1,2 The present study presents a unique reconstruction of an anterior chest wall soft tissue defect that occurred after tumour resection using a TAAP flap based on the clavicular branch perforator. Its pliability, thin structure, property of preservation of the muscle, compatibility in skin contour and texture are considered advantages of the flap.…”

“…Consequently, the pectoralis major flap is used mainly for chest wall and upper arm reconstruction. 1 In contrast, there are few reports on the clinical use of the TAAP flap. Reconstructions of the head, neck and axillary regions with TAAP flaps have been previously described.…”