Microsurgical pedicle lengthening for pedicled thoracodorsal artery perforator flap transfer

The pedicled thoracodorsal artery perforator flap has been shown to be an effective option for reconstruction of various regions, including the breast, axilla, upper arm, lateral chest, and shoulder area. However, the original length of the pedicle limits the flap's reach to remote locations. We devised a technique that involves microsurgical lengthening of the pedicle to extend the arc of rotation of the pedicled perforator flap. After exposure of the subscapular vascular tree, we divided the thoracodorsal vessel at the point of bifurcation to the serratus branch and then the pedicle was reconnected to the distal end of the serratus branch. Here, we present 2 cases in which this technique was effectively applied to reconstruct a defect of the elbow using a thoracodorsal artery perforator flap with a pedicle lengthening procedure.