The purpose of the study is to establish a clearly defined principle to prevent the vascular insufficiency of thoracodorsal artery perforator flaps, including the criteria to identify unreliable flaps and the measure to improve their viability.
The whole project comprised the preliminary study and the major study. In the preliminary study of 42 patients, the intrinsic risk factors associated with the vascular insufficiency of flaps were identified. Using colour Doppler scanning, the linear correlation between colour signal width and external diameter of perforators was demonstrated. Based on the findings, the principle to prevent vascular insufficiency of flaps was established which involved two steps. First was introducing the inclusion criteria to identify the unreliable flaps. Second was including extra perforators as the single measure to improve the viability of unreliable flaps. The principle was applied in the major study of 50 patients to prove its efficacy.
In the major study, flap viability was not compromised in the 35 patients without any of the inclusion criteria. At least one of the inclusion criteria was met in the other 15 patients. Three of the 15 unreliable flaps sustained vascular insufficiency. In one patient, only single small-sized perforator was available to support the flap. The principle was disobeyed in the other two patients because of the intertwined relation, and their less dominant perforators were cut to spare the intertwined motor nerves. The rate of compromised flap viability was 2.1% in the 48 patients with complete execution of the principle in comparison with the 16.7% rate in the preliminary study.
The inclusion criteria are useful to identify unreliable thoracodorsal artery perforator flaps. Inclusion of extra perforators is a single and efficient measure to prevent vascular insufficiency of unreliable flaps.
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- The thin latissimus dorsi perforator-based free flap for resurfacing.Plast Reconstr Surg. 2001; 107: 374-382
- Different types of suprafascial courses in thoracodorsal artery skin perforators.Plast Reconstr Surg. 2008; 121: 840-848
- Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap.Plast Reconstr Surg. 2006; 118: 1376-1386
- Initial temporary vascular insufficiency in latissimus dorsi and thoracodorsal perforator flaps.Plast Reconstr Surg. 2009; 124: e408-e418
- Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps.Plast Reconstr Surg. 2005; 115: 755-763
- Sensate thoracodorsal artery perforator flap: a focus on its preoperative design and harvesting technique.Plast Reconstr Surg. 2009; 123: 163-174
- Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients.Plast Reconstr Surg. 2008; 121: 1632-1641
- Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site.Plast Reconstr Surg. 2003; 111: 1407-1411
- Shoulder function after harvesting a thoracodorsal artery perforator flap.Plast Reconstr Surg. 2008; 122: 1111-1117
- A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity.Plast Reconstr Surg. 2004; 113: 1175-1183
- Three- and four-dimensional arterial and venous anatomies of the thoracodorsal artery perforator flap.Plast Reconstr Surg. 2008; 121: 1578-1587
- The perforasome theory: vascular anatomy and clinical implications.Plast Reconstr Surg. 2009; 124: 1529-1544
- The vascular basis of the thoracodorsal artery perforator flap.Plast Reconstr Surg. 2005; 116: 818-822
- The thoracodorsal artery perforator flap: anatomic basis and clinical application.Ann Plast Surg. 2003; 51: 23-29
- Doppler flowmetry in the planning of perforator flaps.Br J Plast Surg. 1998; 51: 202-209
- Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer.Plast Reconstr Surg. 2008; 122: 1079-1088
- Magnetic resonance angiography in preoperative planning of deep inferior epigastric artery perforator flaps.J Plast Reconstr Aesthet Surg. 2009; 62: 1661-1665
- Image-guided perforator flap design using invisible near-infrared light and validation with X-ray angiography.Ann Plast Surg. 2009; 63: 327-330
- Color Doppler Ultrasonography in the planning of microvascular augmented “super-thin” flaps.Plast Reconstr Surg. 2003; 112: 822-828
- Preoperative assessment of anterolateral thigh flap cutaneous perforators by colour Doppler flowmetry.Br J Plast Surg. 2003; 56: 21-25
- Thoracodorsal artery perforator (TAP) flap: Report of our experience and review of the literature.Br J Plast Surg. 2002; 55: 390-395
- Power Doppler sonography.Radiology. 1996; 200: 21-23
- Power Doppler US: a potentially useful alternative to mean frequency-based color Doppler US.Radiology. 1994; 190: 853-856
- The unfavorable anatomy of vastus lateralis motor nerves: a cause of donor-site morbidity after anterolateral thigh flap harvest.Plast Reconstr Surg. 2009; 123: 1505-1509
- A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles.Plast Reconstr Surg. 2005; 115: 2070-2073
Published online: September 26, 2011
Accepted: September 6, 2011
Received: July 4, 2011
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.