Thoracodorsal Artery Perforator Flap for Extremity Reconstruction

Resurfacing shallow defects of extremities with an appropriately thin flap is a common but difficult task. This can be accomplished by harvesting the thoracodorsal artery perforator flap from the lateral aspect of the upper back. This flap can be based on the musculocutaneous perforator, which usually emerges in an area ~8 to 10 cm below the posterior axillary fold and 2 to 3 cm posterior to the lateral border of the latissimus dorsi muscle, or the septocutaneous perforator of the thoracodorsal artery, which emerges anterior to the lateral border of the latissimus dorsi muscle. Between February 2001 and May 2005, we used the thoracodorsal artery perforator flap for extremity reconstruction in 18 clinical cases. The existing soft tissue defects among all patients resulted from trauma, scar release, chronic ulcer, and tumor ablation. The main advantages of the thoracodorsal artery perforator flap are that it only requires cutaneous tissue to achieve better accuracy in reconstructive site and it minimizes the donor-site morbidity by preserving the function of the latissimus dorsi muscle and hiding the prominent scar of the donor region. However, searching for a reliable perforator and the tedious process of intramuscular retrograde dissection of the perforator are time-consuming and skill-demanding. KEYWORDS Thoracodorsal artery perforator flap - extremity reconstruction - musculocutaneous perforator - septocutaneous perforator