The thoracodorsal artery perforator flap has attracted great interest because its distinct advantages including a long donor vessel that can reach a. This artery is found within a triangle limited anteriorly by the vastus lateralis muscle. Distal posterior tibial artery perforator flaps for the treatment of. The toracodorsal perforator flap, based on cutaneous vessels from toracodorsal artery and vein that pass through latissimus dorsi muscle, is a modified. We present our experience of 5 cases with the adipofascial forearm flap for upper extremity soft tissue defects including dorsal hand or proximally base wounds of the elbow. Recently, surgeons have begun to combine implantbased reconstruction with flaps that sacrifice less ld muscle. In our department, the thoracodorsal artery perforator tdap flap is widely used as free flap for large defects on extremities. Thoracodorsal artery perforator tdap flap is one of the relatively new techniques in breast reconstruction. Thoracodorsal artery perforator flap dissected and deepithelialized b. Lateral genicular artery flap for reconstruction of a large. The authors present an alternative source using posterior thigh soft tissue based on profunda artery perforators, termed the profunda artery perforator flap. The technique of perforator dissection is a skill attributed. The procedure aims to replace the lost breast tissue removed at the time of cancer surgery with skin and fat from under your arms and restore the size and shape of your breast.
The versatility of profunda femoral artery perforator flap for. A total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. The skin paddle can be from 18 cm wide and up to 55 cm long can be harvested on a single perforator. Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix tarek hashem1,2 and ahmed farahat1 abstract background. This flap showed constant anatomy 10 and, as previously stated, is a useful and reliable tool in the plastic surgery arma.
Download as an information leaflet pdf medial sural artery perforator free flap msap a medial sural artery perforator free flap is also known as an msap flap. Allen at the th international course on perforator flaps in mexico city. The anatomy of the thoracodorsal artery in perforator flap. Regarding the territory of the digital artery perforator flap, two vascular systems can be selected as the candidate pedicle for this flap. May 01, 2016 radial artery perforator based distal hand flaps. Reconstructive surgery evolved as a result of the enormous numbers of world war i and ii victims, long before profound knowledge of the vascularity of flaps was present. Lateral flap of the thigh based upon the lateral superior. The other is the superficial arteriolar system, which is the terminal. The thoracodorsal artery perforator flap request pdf.
Digital artery perforator flaps for fingertip reconstructions. Extended thoracodorsal artery perforator flap for breast. This perforator can be included and cut at the distal end, that is, towards its origin from the intercostals artery. In the digital artery island flap technique, a major artery is compromised. Lateral genicular artery flap for reconstruction of a. Five was then released and perfusion of the flap confirmed. Deep inferior epigastric perforator flap reconstruction. Since angrigiani et al described the concept of the thoracodorsal artery perforator flap, the harvesting technique of the latissimus dorsi musculocutaneous flap. Clinical application of the thoracodorsal artery perforator flaps. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. As such, a new model for abdominal wall perfusion has become necessary.
Inadvertent free intercostal artery perforator flaps. A surgical technique for obtain ing propeller perforator flaps in the lower leg was described by teo 6 in 2010. The thin, pliable and preservation of the radial and ulnar artery make the adipofascial perforator flap the ideal flap for the upper extremity. Superficial circumflex iliac artery perforator flap for. It yields a relatively long, thin and pliable skin flap and a. Angrigiani et al 1 first described harvesting a cutaneous island of the latissimus dorsi flap without the muscle based on one cutaneous perforator. If there is a potential to harvest multiple perforator flaps from one vessel, the name of each flap should be based on its anatomical region or muscle. This perforator finally pierces the deep fascia to enter the skin of the lower twothirds of the lower leg.
Postoperative anterior view c shows optimal evolution of the cutaneous flap island. Medial sural artery perforator free flap msap british. Erratum to propeller thoracodorsal artery perforator flap. This artery is found within a triangle limited anteriorly by the vastus lateralis muscle, posteriorly by the short head of the biceps femoris muscle. Propeller perforator flaps from the dorsal digital artery perforator. Thoracoacromial artery perforator flap request pdf. Above, right the thoracodorsal artery perforator flap offers an arc of 90 degrees clockwise and counterclockwise. Apr 02, 2016 this perforator finally pierces the deep fascia to enter the skin of the lower twothirds of the lower leg. The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their. The detailed surgical technique with its variations is.
The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. The perforator was injected with contrast medium and the flap was then subjected to computed tomographic scanning using a ge lightspeed 16slice scanner. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels. Freestyle local perforator flaps for facial reconstruction. The flap vascularization is supplied by the skin perforator of the lateral superior genicular artery lsga, the right branch of the popliteal artery 11,14. Multidetector computed tomographic imaging in 20 female patients with a mean age of 47 years revealed an equal number of dominant perforators 10 left and 10 right. Application of the dorsal metacarpal artery perforator flap for resurfacing softtissue defects proximal to the fingertip. Although some reports indicate that freestyle perforator flaps have been used to cover defects of the trunk or extremities, the use of such flaps for facial reconstruction was only recently introduced.
Extended thoracodorsal artery perforator flap for breast reconstruction a total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. With the development of microsurgical technique, the anastomosis of vessels with. The perforators of the flap run within the lateral intermuscular septum, which separates the brachialis from the triceps muscle fig. One is the main perforator arising from the digital artery that nourishes a wide, large flap, as in the patient in case 2 4 2 cm. It essentially involves the transfer of the patients own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound. Thoracodorsal artery perforator flap for partial breast. The posterior tibial artery is the direct terminal of the pop liteal artery and it is invariably the largest branch of the popliteal artery. Thoracodorsal artery perforator flap tap flap microsurgeon. Perforator flaps and fat tissue transplant are new concepts in this kind of reconstruction. Three and fourdimensional arterial and venous anatomies. Request pdf thoracodorsal artery perforator flap for partial breast reconstruction the popularity of breast conservation therapy bct for the management of women with breast cancer continues.
Lateral intercostal artery perforator licap flap has been used for a lot of indications. Extended thoracodorsal artery perforator flap for breast reconstruction. This is not the extensive transposition seen with the musculocutaneous flap, because the radius of the thoracodorsal artery perforator arc is. These flaps include the musclesparing latissimus dorsi msld flaps that were described by hamdi et al 9 in 2004 and the thoracodorsal artery perforator tdap flap that was first described by angrigiani et al 10 in 1995. Large when taken up to the thoracodorsal or subscapular system. Only one flap was debulked with suction assisted lipectomy at a second stage. In the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction was published with some errors the legends of preoperative a marks. Ten cadaveric thighs were dissected centered over the profunda artery perforator. Application of posterior thigh threedimensional profunda. In one specimen, this perforator was located more distally, 15 cm from the popliteal crease. For raising a flap based on the peroneal artery perforator, the patient is also supine with a. The myocutaneous flap, such as latissimus dorsi flap or rectus abdominis flap, is useful option for the large and deep defect. Figure 6 a a 22yearold male presented with a left foot degloving injury with. The tourniquet distallybased island ulnar artery perforator flap.
Deep inferior epigastric perforator flap diep reconstruction is a type of breast reconstruction surgery. Perforator local flaps in lower limb reconstruction. We present our experience of 5 cases with the adipofascial forearm flap for upper extremity soft tissue defects including dorsal hand or. The medical files of the authors patients who underwent lumbar artery perforator flap breast reconstruction were also analyzed. Anatomy posterior intercostal bundle the anatomy and course of the intercostal vessels have been thoroughly studied in the anatomical. In presented case, the perforator artery was found located at approx. Profunda artery perforator pap flap for breast reconstruction.
The vessels that supply blood to the flap are isolated perforators derived from a deep vascular system through the underlying muscle or intermuscular septa. It has been championed as an alternative to the tug flap. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. Outcome of free digital artery perforator flap transfer for. The intercostals perforator is noted to join the thoracodorsal artery by a connecting vessel.
The previously described perfusion zones of the abdominal wall vasculature are based on filling of the deep inferior epigastric artery diea and all its branches simultaneously. We have performed freetissue transfer of a lateral intercostal artery perforator licap flap as classified by hamdi et al. Background the profunda feomris artery perforator pap flap was recently revisited and gains popularity as an alternative method of. Internal mammary artery perforator imap flap is the major tissue source for head and neck. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. Between june 2004 and june 2006, seven patients of sof t the flap was then islanded on a suitable per forator, and the tissue defects on the volar aspect of the wrist under went remaining wer e temporarily micr o clamped. The pap flap for breast reconstruction was originated in 2010 by dr. The thoracodorsal artery perforator tdap flap is based on the branches of the thoracodorsal artery as they pass through the latissimus dorsi to perfuse the overlying soft tissue. Design of internal mammary artery perforator island pedicle flap with. The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three and fourdimensional computed tomographic angiography and venography. It essentially involves the transfer of the patients own skin and subcutaneous tissues from the lower abdominal wall to the chest to form.
Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Saintcyrthoracodorsal artery perforator flap and latissimus dorsi myocutaneous flap anatomical study of the constant skin paddle perforator locations j plast reconstr aesthet surg, 63 2010, pp. A perforator flap should be named after the nutrient artery or vessels and not after the underlying muscle. We have used the internal mammary artery perforator imap flap for the reconstruction of the contralateral small to medium sized chest wall defect and obtained good results with minimal donor site morbidity 4. Indeed, the profunda artery perforator pap flap, which uses the skin and fat of the posterior thigh, has surpassed the gluteal artery perforator gap flap in our practice as the second line donor site for microsurgical breast reconstruction. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites.
Flaps based on the ulnar artery have never gained the same popularity as the radial forearm flap, despite several potential advantages. Lateral breast defect after partial mastectomy is a difficult challenge. A second perforator wasfoundinthe medial row at 10 cm distal to the popliteal crease. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction. T1 perforator patterns of the ulnar artery perforator flap.
The profunda femoris artery supplies the tissue of the posterior thigh through musculo and septocutaneous perforators. Since the acromial artery and vein had been identified in the defect as good recipient vessels, the flap pedicle only required dissection as far as the costal portion of the intercostal artery. Free digital artery perforator flap is suitable for repairing fingertip defect, with. Pedicled perforator flap is a new indication for breast surgery.
Therefore, finding a new repair method for finger skin defects is an. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based. For raising a flap based on the posterior tibial artery perforator, the patient is placed in a supine position and the leg is slightly abducted and externally rotated. Later on, several other reports concerning the use of this flap have been published2,512. Surgical anatomy of the medial sural artery perforator flap wong et al. Application of posterior thigh threedimensional profunda artery perforator perforasomes in refining nextgeneration flap designs. The first patient was a 52yearold woman who had undergone previous attempts at breast reconstruction with a failed transverse rectus abdominis muscle tram flap and a failed implant. Anatomy of the latissimus dorsi muscle everything you need to know dr. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires breast plastic and reconstructive surgeons at johns hopkins medicine also. The latissimus dorsi ld is largely used in breast surgery, which results in the sacrifice of one of the most important muscles for shoulder function. With the advent of the diea perforator flap, only a single or several perforators are included in supply to the flap. Transverse, vertical, and sshaped profunda artery perforator flaps. It yields a relatively long, thin and pliable skin flap and a good aesthetic result.
Lateral intercostal artery perforator licap flap breast. Apr 02, 2016 the lateral upper arm flap is supplied by septocutaneous branches of the posterior radial collateral artery prca, which develops from the profunda brachii artery. Original article distal posterior tibial artery perforator. The thoracodorsal artery perforator scapular osteocutaneous tdap soc flap for reconstruction of palatal and maxillary defects. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Predictable pattern digital artery perforator flap ncbi. Thoracodorsal artery perforator flap as an autologous. With this concept, operations were carried out on the basis of facial artery perforators, nasolabial artery perforators, postauricular artery perforators, or submental artery. This flap is the equivalent of the latissimus myocutaneous flap without the inclusion of the musculature of the latissimus. Perforator patterns of the ulnar artery perforator flap md. Use of thoracodorsal artery perforator flaps to enhance. Jun 22, 20 anatomy of the latissimus dorsi muscle everything you need to know dr. Surgical anatomy of the medial sural artery perforator flap.
The thoracoacromial artery perforator taap flap used in its pedicle or in the free microvascular variant is an emerging flap for use as a reconstructive option for the head and neck. The flap was transposed onto the breast anterolateral and posterolateral chest wall. The versatility of the intercostal artery perforator. The lateral upper arm flap is supplied by septocutaneous branches of the posterior radial collateral artery prca, which develops from the profunda brachii artery. Thoracodorsal artery perforator flap for extremity. The versatile clinical use of the intercostal artery perforator. The thoracodorsal artery perforator flap has attracted great interest because its distinct advantages including a long donor vessel that can reach a recipient vessel far from traumatized or. It supplies ap proximately 10 percent of the integument of the lower leg 10. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts.
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