Application of various compositions of thoracodorsal perforator flap for craniofacial contour deformities

Craniofacial contour defects are challenging to restore because they may involve multiple tissues and span several aesthetic subunits in a non-contiguous manner. Some of these deformities may be associated with significant dead space in the region of sinus and orbit. The numerous subtle contours of the craniofacial regions must be preserved or restored to achieve a pleasing outcome.

We managed six patients with various craniofacial contour deformities as a result of hemifacial microsomia, infection, post excision of venous malformation, lipodystrophy, craniectomy for chronic frontal sinusitis and infected pneumocephalus. They were reconstructed with thoracodorsal perforator flaps bearing various components, that is, adiposal, adipofascial, dermoadiposal, adipomyofascial and osteomuscular elements. Half of the flaps were in chimaeric form. The largest flap size was 11 × 17 cm. All flaps survived and no patient required secondary contouring procedure, except for cranioplasty in one patient.

The thoracodorsal perforator flap is very suitable for restoration of craniofacial contour deformities. Its advantages include: (1) ease of customisation of size and thickness, (2) several choices of donor tissue from the lateral thoracic region yielding multiple tissue components, for example, adiposal, adipofascial, dermoadiposal, adipomyofascial and osteomuscular flaps, (3) presence of adjacent perforators in the thoracodorsal system, allowing chimaeric flap configuration, thereby improving adaptation to non-contiguous contour defects, (4) ability to tailor the donor and recipient vessel size match by varying how proximal to harvest along the thoracodorsal vessels, (5) primary closure of donor site and (6) flap harvesting in supine position allowing a two-team approach.