Upper Extremity Sarcoma Reconstruction with a Pedicle Thoracodorsal Artery Perforator Flap

Soft tissue sarcomas (STS) are a rare, heterogeneous group of tumors (1% of all the malignancies). Approximately 50% of STS occur in the extremities and 30% of these are located in the upper limbs.[ 1 ] Limb preservation surgery is now the accepted standard treatment for patients with STS with less than 5% necessitating amputation. Local control of sarcoma is best achieved by adequate resection at the primary tumor stage. However, as the upper limb presents specific and unique anatomical architecture with little soft tissue, narrow compartment, and important structure in close proximity, the large defects involving this area soft tissue represent a challenging problem in reconstructive surgery.[ 2 ] [ 3 ] Although many surgical techniques are available for reconstruction of soft tissue defects of the upper arm, challenges remain in achieving a satisfactory reconstruction. Over the past few years the thoracodorsal artery perforator (TDAP) flap have been used as free flap in such area as the skull base, upper and lower extremity, or pedicle flap for reconstruction of regional defects in the trunk, head and neck, axilla, and breast.[ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] Despite the increasing advances in perforator flap design and perforator imaging, there is a relative paucity of data evaluating the use of pedicle thoracodorsal artery perforator flaps in upper limb reconstruction. Here, we present (1) a brief literature review evaluating the applicability and reliability of pedicle TDAP flaps performed and (2) a case illustrating the concept of a pedicle perforator flap based on perforators arising from the thoracodorsal artery used to resurface a large wound of the antecubital fossa due to sarcoma surgery. * Both the authors contributed equally to this work and should be consider first co-authors.