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[Extension of the thoracodorsal artery perforator flap's pedicle: Anatomical study]
M Lenglet1, S Dast1, L Dessena2
1Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens Picardie, Salouel, 80054 Amiens cedex, France.
Purpose:
In recent years, the indications of latissimus dorsi myocutaneous flap decreased in favor of its version preserving muscle: the thoracodorsal artery perforator flap (TDAP). The intramuscular dissection reduce donor site morbidity but also allows an extension of the pedicle compared to conventional latissimus dorsi flap pedicle. The purpose of this study was to quantify objectively elongation of the pedicle when the perforator is dissected through the muscle.
Method:
Sixteen TDAP flap were dissected in 9 cadavers. The pedicle was divided into 4 distinct parts: (1) hypodermis, (2) subcutaneous fat, (3) intramuscular, (4) conventional pedicle.
Results:
The length of the pedicle is significantly increased when the pedicle is dissected through the muscle. This extends the theoretical length from 5.25cm up to 9.19cm if the dissection is extended to the deep fat. Indeed, this results in a potentially exploitable TDAP pedicle length of 20.66cm.
Conclusion:
The dissection of the perforator allows an extension of the pedicle of about 5 or 9cm if we continue the dissection in the subcutaneous fat. A long pedicle may be interesting in lower limb reconstructive surgery and facial reconstruction where microsurgery is not feasible.