The key landmark for localizing the vascular pedicle is the sartorius muscle fig. The thoracodorsal artery perforator flap first reported by angrigiani was based on the latissimus dorsi myocutaneous flap. Emergency repair of upper extremity large soft tissue and. Lateral flap of the thigh based upon the lateral superior. This innovation had been accomplished in breast reconstruction by the development of the superior gluteal artery perforator s gap free flap by allen and tucker4. The skin paddle is designed by including the perforator identi. This is usually done in selected cases, and is typically used for augmenting the volume or perfecting the contour of alreadyreconstructed breasts. Erratum to propeller thoracodorsal artery perforator flap. Lateral intercostal artery perforator licap flap breast.
Digital artery perforator flaps for fingertip reconstructions. Extended thoracodorsal artery perforator flap for breast reconstruction. The sensate free superior gluteal artery perforator sgap flap. The superior and inferior gluteal artery perforator flaps. Extended thoracodorsal artery perforator flap for breast. One is the main perforator arising from the digital artery that nourishes a wide, large flap, as in the patient in case 2 4 2 cm. Thoracoacromial artery perforator flap request pdf. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects. Transverse, vertical, and sshaped profunda artery perforator flaps. In the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors. A line should be drawn from the anterior superior iliac spine to the medial epicondyle of the tibia, approximating the course of the muscle. The detailed surgical technique with its variations is. The anatomy of the thoracodorsal artery in perforator flap.
Dissection is performed from distal to proximal in order to identify the musculocutaneous perforator. Objective the anterolateral thigh alt flap has become a frequently used free flap for head and neck reconstruction. Vascular anatomy of the ulnar artery perforator flap article pdf available in plastic and reconstructive surgery 11. In a supine position, with the ipsilateral arm free to open the axillary region, the lateral border of the perforator flap is outlined on the lateral thoracic region. As such, a new model for abdominal wall perfusion has become. This procedure uses excess skin and fat from the gluteal buttock region and leaves all the gluteal muscle behind. Our group first described the thoracodorsal artery perforator flap tdap in 1995, in an attempt to minimize donorsite complications related to the latissimus dorsi muscle cutaneous flap 1. Hayakawa, md, frcsc the thoracodorsal artery perforator or tap flap is a fasciocutaneous flap based on a musculocutaneous perforator or perforators from the thoracodorsal vessel axis andor its vertical branch derivative. Nov 07, 2017 this video demonstrates the propellar flap based on the perforators of posterior tibial artery for medial malleolar defect. Free style perforator flaps for aesthetic facial reconstruction.
Preoperative doppler auditory examinations are sometimes useful to confirm the existence of dominant muscle perforators of the thoracodorsal artery perforator flap. Erratum to propeller thoracodorsal artery perforator flap for. Thoracodorsal artery perforator tdap flap harvests upper back skin and fat to create the breasts. The thoracodorsal artery perforator flap has attracted great interest because its distinct advantages including a long donor vessel that can reach a recipient vessel far from traumatized or.
Newer applications for perforator flaps are being developed as this issue of seminars in plastic surgery is being published. The icap flap is also a logical choice for wound closure, if required. Lateral genicular artery flap for reconstruction of a. The versatility of the intercostal artery perforator icap. Mohan, lin zhu, yoo joon sur, mohamed morsy, gregory j.
An assessment of the anatomical basis of the thoracoacromial. Regarding the territory of the digital artery perforator flap, two vascular systems can be selected as the candidate pedicle for this flap. Dec 06, 2017 erratum to propeller thoracodorsal artery perforator flap for breast reconstruction in the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction 1 was published with some errors. Pdf vascular anatomy of the ulnar artery perforator flap.
Jun 22, 20 operative video for free tap harvesting. As a result, widespread use of perforator flaps, either pedicled or free, has become possible. This perforator finally pierces the deep fascia to enter the skin of the lower twothirds of the lower leg. Gap flap breast reconstruction prma plastic surgery. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Later on, several other reports concerning the use of this flap have been published2,512.
The recruitment of the chest skin through a thoracoacromial artery perforator flap resulted in an adequate color match, texture, and pliability for local adjacent defect restoration and for head. The recent introduction of chimeric sentinel muscle perforator flaps for free flap monitoring, local perforator flaps for lower extremity reconstruction, and perforator to perforator free flaps is simply the beginning. The free thoracodorsal artery perforator flap in head and. It has been championed as an alternative to the tug flap. The superior and inferior gluteal artery perforator flaps have been used clinically, yet the published anatomical studies describing the blood supply to the gluteal skin are inadequate.
With the advent of the diea perforator flap, only a single or several perforators are included in supply to the flap. Thoracodorsal artery perforator flap in breast reconstruction. The anterior tibial at artery begins at the inferior border of the popliteus muscle, branching from the bifurcation of the popliteal artery, passes between the two heads of the tibialis posterior, through the interosseous membrane, and to the deep part of the anterior leg. Using a free thoracodorsal artery perforator flap for phallic. This flap which was supplied by thoracodorsal artery retained latissimus dorsi muscle and thoracodorsal nerve, so it was suitable for repair of trunk and limb defects in pedicled or free form, and also for repair of maxillary defect with scapula. Kao hk, chang kp, chen ya, wei fc, cheng mh 2010 anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Advocates of this technique generally believe that a free flap is associated with a high survival rate and reduced damage to the donor site. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. The aim of this work was to study and evaluate the role of thoracodorsal artery perforator flap in breast reconstruction as regard indications, contraindications, advantages and.
Thoracodorsal artery perforator flap dissected and deepithelialized b. This pdf is available for free download from a site hosted by medknow publications. Figure 6 a a 22yearold male presented with a left foot degloving. This study comprehensively evaluated the anatomical basis of these flaps to present anatomical landmarks to facilitate flap dissection.
Herein, we report 5 patients treated with flowthrough anterolateral thigh free flaps during reconstructive surgery to repair large soft tissue and vascular injuries of the upper extremity. It yields a relatively long, thin and pliable skin flap and a good aesthetic result. The free alt flap is based on the perforators from the descending branch of the lateral circumflex femoral artery in most cases, but the flap can also be supplied by. This has the advantage of providing large flowthrough free flaps, with a minimal conspicuous scar at the donor site. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction. Deep inferior epigastric perforator flap diep reconstruction is a type of breast reconstruction surgery. Can j plast surg vol 11 no 1 spring 2003 23 an assessment of the anatomical basis of the thoracoacromial artery perforator flap christopher robert geddes bsc, maolin tang md, daping yang md, steven f morris md, msc, frcsc department of anatomy, neurobiology and surgery, faculty of medicine, dalhousie university, halifax, nova scotia. The versatility of the intercostal artery perforator. The neurovascular bundle should be preserved at the volar and at the 20% to 25% distal part of the island. Thoracodorsal artery perforator flap for extremity. Outcome of free digital artery perforator flap transfer for. The inthecrease inferior gluteal artery perforator flap.
The free thoracodorsal artery perforator flap offers a long donor vessel that can reach the recipient vessel distant to traumatized or irradiated defects, homogeneous flap thinness that can be used for resurfacing shallow. The size, number, and location of perforators were recorded intraoperatively. The flap vascularization is supplied by the skin perforator of the lateral superior genicular artery lsga, the right branch of the popliteal artery 11,14. Widespread use has been based on literature of alt flap thickness performed primarily in asian populations. All cases were performed with vigorous debridement, after which the peroneal artery perforator flaps were applied. Propellar flap based on posterior tibial artery perforators. Thirtyeight consecutive patients who underwent ulnar artery perforator flap surgery were included in the study. The recent introduction of chimeric sentinel muscle perforator flaps for freeflap monitoring, local perforator flaps for lower extremity reconstruction, and perforatortoperforator free flaps is simply the beginning. This flap provides adequate tissue to perform the reconstruction. The purpose of this study was to report our experience with the free thoracodorsal artery perforator flap for reconstruction of the oropharynx and soft palate in head and neck cancer using a. Koshima et al initially described a pedicled gluteal perforator flap in 1993 but it was based on short parasacral perforating vessels. Erratum to propeller thoracodorsal artery perforator flap for breast. Schematic drawing of the innervated digital artery perforator flap. The other is the superficial arteriolar system, which is the terminal.
The previously described perfusion zones of the abdominal wall vasculature are based on filling of the deep inferior epigastric artery diea and all its branches simultaneously. Innervated digital artery perforator flap sciencedirect. Three and fourdimensional arterial and venous anatomies. The pap flap for breast reconstruction was originated in 2010 by dr.
Freestyle local perforator flaps for facial reconstruction. Postoperative anterior view c shows optimal evolution of the cutaneous. Medial sural artery perforator free flap msap british. The facial artery, the biggest perforator vessel of the body presenters. Surgical anatomy of the medial sural artery perforator flap wong et al. Profunda artery perforator pap flap for breast reconstruction. Superficial circumflex iliac artery perforator scip flap presenter. A total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap.
Regarding the nomenclature, one is free to add the type of transfer to the name of a flap. Peroneal artery perforator flap for the treatment of chronic lower. Propeller perforator flaps from the dorsal digital artery perforator. Women who do not have an adequate amount of abdominal tissue for a diep flap or siea flap reconstruction may be candidates for gap gluteal artery perforator flap breast reconstruction. Surgical anatomy of the medial sural artery perforator flap. The sural artery perforator flap can provide thin and pliable tissue for covering of a knee defect, but the size of the flap is rather limited 7, 8. Extended thoracodorsal artery perforator flap for breast reconstruction a total of 45 patients underwent partial or total autologous breast reconstruction after skinsparing mastectomy, skinreducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator tdap flap. The versatile clinical use of the intercostal artery perforator. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options.
The inthecrease inferior gluteal artery perforator flap for. This video demonstrates the propellar flap based on the perforators of posterior tibial artery for medial malleolar defect. The deep circumflex iliac artery perforator flap for breast. The objective of this study was to document the vascular anatomy of this. Perforator patterns of the ulnar artery perforator flap md. The intercostal artery perforator icap flap provides an option when additional volume is desired in the lateral portion of the breast after a primary reconstruction. We report the first phallic reconstruction using a free thoracodorsal artery perforator flap in a femaletomale transsexual.
Anterior tibial artery perforator flap plastic surgery key. Application of posterior thigh threedimensional profunda artery perforator perforasomes in refining nextgeneration flap designs. Autologous breast reconstruction using abdominalbased perforator flaps. Propeller thoracodorsal artery perforator flap for breast. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. The anterior tibial artery perforator atap flap is vascularized by perforators of the anterior tibial artery and has been reported by several authors 1.
We present our clinical experience with free style facial perforator flaps, surgical technique. The procedure aims to replace the lost breast tissue removed at the time of cancer surgery with skin and fat from under your arms and restore the size and shape of your breast. With the development of microsurgical technique, the anastomosis of vessels with. Propellar flap based on posterior tibial artery perforators nikhil. Deep inferior epigastric perforator flap reconstruction. The thoracodorsal artery perforator flap request pdf. Free thoracodorsal artery perforator flap in extremity. New thoracodorsal artery perforator tapcp flap with. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated. Comprehensive analysis of the anterolateral thigh flap. Perforator patterns of the ulnar artery perforator flap.
Saphenous artery perforator flap plastic surgery key. Pdf download for the deep circumflex iliac artery perforator flap for breast. A profunda artery perforator occasionally two was consistently found in the upper medial thigh region, posterior to the gracilis muscle. May 24, 2015 kao hk, chang kp, chen ya, wei fc, cheng mh 2010 anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. To our knowledge, to date there has not been a comprehensive analysis of. Lateral intercostal artery perforator licap flap breast reconstruction is suitable for some patients whose breast cancer is in the outer part of the breast. Anatomical study of the superior gluteal artery perforator. The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three and fourdimensional computed tomographic angiography and venography.
Better understanding of vascular anatomy and pattern of skin circulation has become. Three and fourdimensional arterial and venous anatomies of. This artery is found within a triangle limited anteriorly by the vastus lateralis muscle, posteriorly by the short head of the biceps femoris muscle. The area of vascularity shown by the spread of contrast extends inferiorly beyond the usual lower border of the profunda artery perforator flap, which is usually 7 cm wide. The thoracodorsal artery perforator flap is a cutaneous flap based on cutaneous perforators of the thoracodorsal vessels.
The inthecrease inferior gluteal artery perforator flap for breast reconstruction robert j. It essentially involves the transfer of the patients own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound. Using a free thoracodorsal artery perforator flap for. The pedicle includes the digital artery, perforators, and the digital nerve.
The main advantages of the thoracodorsal artery perforator flap are that it only. After koshima et al11 reported their cases on the perforator flaps. Application of posterior thigh threedimensional profunda. Free digital artery perforator flap is suitable for repairing fingertip defect, with. As an alternative, the thoracodorsal artery perforator flap is a versatile flap used for the resurfacing of various soft tissue defects and it has many advantages. In the august 2014 issue of gland surgery, the original article propeller thoracodorsal artery perforator flap for breast reconstruction was published with some errors the legends of preoperative a marks. Erratum to propeller thoracodorsal artery perforator flap for breast reconstruction. Since then, several studies have demonstrated that the use of musclesparing latissimus dorsiflap is feasible and ensures excellent objective and. Perforator free flaps harvested from the abdomen or buttock are excellent options for breast reconstruction. Fasciocutaneous propeller flap based on perforating branch of.