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04.03.2017 | Anatomic Bases of Medical, Radiological and Surgical Techniques

Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume

verfasst von: Sandy Dast, Eric Havet, Lidia Dessena, Abeer Abdulshakoor, Mohammed Alharbi, Richard Vaucher, Christian Herlin, Raphael Sinna

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 8/2017

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Abstract

Introduction

The concept of extended thoracodorsal artery perforator (TDAP) flap was described in 2015 for breast reconstruction. Our anatomical study aims to identify the territories vascularised by the thoracodorsal artery perforator via the deep muscular fascial network. The second goal was to define the volume of the extended TDAP flap.

Materials and method

Ten extended TDAP flaps were dissected on 5 fresh human cadavers. Around the classical skin paddle of a TDAP flap, the dissections were performed in a subfascial level, including the muscular fascia and the adipose tissue compartments to increase the volume of the flap. After injection of methylene blue in the thoracodorsal artery, we measured the length and width, the surface and the volume of the coloured flap.

Results

The mean sizes of the extended TDAP flap were 24.9 cm × 20.1 cm. The mean surface of the total vascularization zone was 441 cm². The mean volume of the vascularized flap was 193 ml.

Conclusion

The thoracodorsal artery perforator via the deep muscular fascial network allows us to harvest a flap of 25 cm × 20 cm with a mean surface of 441 cm² and a mean volume of 193 ml. The extended TDAP flap is a credible option in breast reconstruction.

Adams WP Jr, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ (2004) Functional donor site morbidity following latissimus dorsi muscle flap transfer. Ann Plast Surg 53:6–11CrossRefPubMed

Angrigiani C, Grilli D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96:1608–1614CrossRefPubMed

Angrigiani C, Rancati A, Escudero E, Artero G. (2015) Extended thoracodorsal artery perforator flap for breast reconstruction. Gland Surg. 4:519–527.PubMedPubMedCentral

Bellino S, Fenocchio M, Zizza M, Rocca G, Bogetti P, Bogetto F (2011) Quality of life of patients who undergo breast reconstruction after mastectomy: effects of personality characteristics. Plast Reconstr Surg 127:10–17CrossRefPubMed

Blondeel PN, Van Landuyt KHI, Monstrey SJM, Hamdi M, Matton GE, Allen RJ, et al. (2003)The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 112:1378–83; quiz 1383, 1516; discussion 1384–7.

Breidenbach WC, Adamson W, Terzis JK (1987) Medial arm flap revisited. Ann Plast Surg 18:156–163CrossRefPubMed

Breuing KH, Colwell AS (2007) Inferolateral AlloDerm hammock for implant coverage in breast reconstruction. Ann Plast Surg 59:250–255CrossRefPubMed

Breuing KH, Warren SM (2005) Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 55:232–239CrossRefPubMed

Bostwick J, Nahai F, Wallace JG, Vasconez LO (1979) Sixty latissimus dorsi flaps. Plast Reconstr Surg 63:31–41CrossRefPubMed

10.

Campbell DA (1950) Reconstruction of the anterior thoracic wall. J Thorac Surg 19:456–461PubMed

11.

Delay E, Gounot N, Bouillot A, Zlatoff P, Rivoire M (1998) Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients. Plast Reconstr Surg 102:1461–1478CrossRefPubMed

12.

Guerra AB, Metzinger SE, Lund KM, Cooper MM, Allen RJ, Dupin CL (2004) The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg 114:32-41-43CrossRef

13.

Gunnarsson GL, Børsen-Koch M, Nielsen HT, Salzberg A, Thomsen JB. (2015) Bilateral breast reconstruction with extended thoracodorsal artery perforator propeller flaps and implants. Plast Reconstr Surg Glob Open. 3:e435.CrossRefPubMedPubMedCentral

14.

Hamdi M, Salgarello M, Barone-Adesi L, Van Landuyt K (2008) Use of the thoracodorsal artery perforator (TDAP) flap with implant in breast reconstruction. Ann Plast Surg 61:143–146CrossRefPubMed

15.

Hamdi M, Van Landuyt K, Monstrey S, Blondeel P (2004) Pedicled perforator flaps in breast reconstruction: a new concept. Br J Plast Surg 57:531–539CrossRefPubMed

16.

Heitmann C, Guerra A, Metzinger SW, Levin LS, Allen RJ (2003) The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg 51:23–29CrossRefPubMed

17.

Jacobs J, Børsen-Koch M, Gunnarsson GL, Tos T, Siim E, Udesen A et al (2016) The versatile extended thoracodorsal artery perforator flap for breast reconstruction. Ann Plast Surg 77:396–400CrossRefPubMed

18.

Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648CrossRefPubMed

19.

Lin C-T, Huang J-S, Hsu K-C, Yang K-C, Chen J-S, Chen L-W (2008) Different types of suprafascial courses in thoracodorsal artery skin perforators. Plast Reconstr Surg 121:840–848CrossRefPubMed

20.

Losken A (2009) Early results using sterilized acellular human dermis (neoform) in post-mastectomy tissue expander breast reconstruction. Plast Reconstr Surg

21.

Moore TS, Farrell LD (1992) Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg 89:666–672 discussion 673–4.CrossRefPubMed

22.

Nahabedian MY (2009) AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg 124:1743–1753CrossRefPubMed

23.

Randolph LC, Barone J, Angelats J, Dado DV, Vandevender DK, Shoup M (2005) Prediction of postoperative seroma after latissimus dorsi breast reconstruction. Plast Reconstr Surg 116:1287–1290CrossRefPubMed

24.

Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E (2011) An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 127:514–524CrossRefPubMed

25.

Schwabegger A, Ninković M, Brenner E, Anderl H (1997) Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 38:594–597CrossRefPubMed

26.

Spear SL, Parikh PM, Reisin E, Menon NG (2008) Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg 32:418–425CrossRefPubMed

27.

Tansatit T, Chokrungvaranont P, Wanidchaphloi S, Sanguansit P (2007) The anatomy of the thoracodorsal artery in perforator flap for resurfacing shallow defect. J Med Assoc Thail Chotmaihet Thangphaet 90:947–955

28.

Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113–141CrossRefPubMed

29.

Thomas BP, Geddes CR, Tang M, Williams J, Morris SF (2005) The vascular basis of the thoracodorsal artery perforator flap. Plast Reconstr Surg 116:818–822CrossRefPubMed

30.

Tschopp H (1991) Evaluation of long-term results in breast reconstruction using the latissimus dorsi flap. Ann Plast Surg 26:328–340CrossRefPubMed

Titel: Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume
verfasst von: Sandy Dast
Eric Havet
Lidia Dessena
Abeer Abdulshakoor
Mohammed Alharbi
Richard Vaucher
Christian Herlin
Raphael Sinna
Publikationsdatum: 04.03.2017
Verlag: Springer Paris
Erschienen in: Surgical and Radiologic Anatomy / Ausgabe 8/2017
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-016-1811-x

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Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume