Kensuke Tashiro1, Shuji Yamashita2, Jun Araki2, Mitsunaga Narushima2, Takuya Iida2, Isao Koshima2. 1. Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: tashirox@gmail.com. 2. Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
INTRODUCTION: The thoracodorsal artery perforator flap with capillary perforators (TAPcp) is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can overcome the drawbacks of the conventional TAP flap, which results in anatomical variations due to the presence of a dominant muscle or septocutaneous perforators. We applied color Doppler ultrasonography (US) to preoperatively visualize capillary perforators of the descending branch of thoracodorsal artery to facilitate successful flap elevation. PATIENTS AND METHODS: Using preoperative color Doppler US, we examined seven flaps in seven patients who had undergone reconstruction with TAPcp flaps between January 2014 and April 2015. Capillary perforators with diameters <0.5 mm were identified in the anterior border of the latissimus dorsi (LD) muscle. Perforator courses and their penetration points were marked to guide dissection. RESULTS: All seven TAPcp flaps were successfully harvested without pedicle damage or perfusion disorders. No serious postoperative complications occurred such as total necrosis or absorption of the transferred adipose flap. In all seven cases, capillary perforators and the descending branch of the thoracodorsal artery were found almost exactly where the preoperative color Doppler US was targeted. CONCLUSION: Using the technique described herein, capillary perforators of the descending branch of the thoracodorsal artery are easily visualized, and TAPcp flaps can be easily used for various kinds of reconstruction. Moreover, this technique is quick and safe to administer.
INTRODUCTION: The thoracodorsal artery perforator flap with capillary perforators (TAPcp) is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can overcome the drawbacks of the conventional TAP flap, which results in anatomical variations due to the presence of a dominant muscle or septocutaneous perforators. We applied color Doppler ultrasonography (US) to preoperatively visualize capillary perforators of the descending branch of thoracodorsal artery to facilitate successful flap elevation. PATIENTS AND METHODS: Using preoperative color Doppler US, we examined seven flaps in seven patients who had undergone reconstruction with TAPcp flaps between January 2014 and April 2015. Capillary perforators with diameters <0.5 mm were identified in the anterior border of the latissimus dorsi (LD) muscle. Perforator courses and their penetration points were marked to guide dissection. RESULTS: All seven TAPcp flaps were successfully harvested without pedicle damage or perfusion disorders. No serious postoperative complications occurred such as total necrosis or absorption of the transferred adipose flap. In all seven cases, capillary perforators and the descending branch of the thoracodorsal artery were found almost exactly where the preoperative color Doppler US was targeted. CONCLUSION: Using the technique described herein, capillary perforators of the descending branch of the thoracodorsal artery are easily visualized, and TAPcp flaps can be easily used for various kinds of reconstruction. Moreover, this technique is quick and safe to administer.
Authors: Andreas Kehrer; Marc Ruewe; Natascha Platz Batista da Silva; Daniel Lonic; Paul Immanuel Heidekrueger; Samuel Knoedler; Ernst Michael Jung; Lukas Prantl; Leonard Knoedler Journal: Diagnostics (Basel) Date: 2022-07-07