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. 2015 May-Aug;48(2):153-8.
doi: 10.4103/0970-0358.163051.

Thoracodorsal artery perforator flap: Indeed a versatile flap

Leena Jain  1 , Samir M Kumta  1 , Shrirang K Purohit  1 , Rashmi Raut  1
Affiliations

Thoracodorsal artery perforator flap: Indeed a versatile flap

Leena Jain et al. Indian J Plast Surg. 2015 May-Aug.

Abstract

Introduction: The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency.

Materials and methods: We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities.

Results: We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily.

Conclusion: The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.

Keywords: Ideal perforator flap; chimerism; septocutaneous perforator; versatile.

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Figures

Figure 1
Figure 1
Flaps can be based on perforators from horizontal or vertical branch of thoracodorsal artery perforator. Perforator landmarks from vertical branch: 8 cm below apex of axilla and 2 cm inside the lateral border of latissimus dorsi muscle
Figure 2
Figure 2
Versatility in perforator type and in designing the flaps depending on the position of the perforator
Figure 3
Figure 3
Versatility in position for flap harvest
Figure 4
Figure 4
Versatility in flap designing — chimeric flaps of different components. Perforator length of about 6 cm
Figure 5
Figure 5
Bilateral foot defect — thoracodorsal artery perforator flap for right foot and latissimus dorsi muscle flap with split thickness skin grafts for the left foot
Figure 6
Figure 6
Tongue reconstruction: Thoracodorsal artery perforator flap markings and harvesting in the supine position. The thinness of the flap along with good length of pedicle is seen. Final result of hemiglossectomy defect reconstruction
Figure 7
Figure 7
Thoracodorsal artery perforator flap for right lower third leg defect - 2 months follow-up
Figure 8
Figure 8
Right elbow defect resurfaced with thoracodorsal artery perforator Flap
See this image and copyright information in PMC

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