Summary
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: September 26, 2011
Accepted:
September 6,
2011
Received:
July 4,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
