[Combined latissimus dorsi-thoracodorsal artery perforator-transpositional free flap]

Reconstruction or complete cover of extended but polygonal defects is limited by the size of transplantable tissue. One of the largest composite tissue components to be transplanted is the myocutaneous latissimus dorsi flap. Under certain circumstances even this large-scale flap is not sufficient for complete defect cover. Based on experiences with the thoracodorsal artery perforator (TAP) flap, the skin island adjacent to the latissimus muscle may be raised, pedicled on the perforator vessels penetrating the underlying muscle. Thus this island may easily be transposed or rotated to enable additional defect cover.

This method was applied in eight patients for defect cover at the extremities, thorax or for hypopharynx reconstruction. The exact location of perforator vessels may be determined pre- or intraoperatively with a hand Doppler so that skin flap transposition can already be planned before surgery.

All of the skin flaps transposed or rotated healed without complications. It may even be assumed that utilizing this method helped to avoid further complications like scar contractures, because tension-free wound closure was feasible.

The combined latissimus dorsi- thoracodorsal artery perforator-transpositional free flap is capable of covering very extensive polygonal as well as defects over joints in order to prevent scar contractions.