Reverse-flow Thoracodorsal Artery: An Additional Perfusion Strategy for Breast Microsurgical Flaps

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Autologous tissue techniques, particularly abdominal perforator flaps, are standard for post-mastectomy breast reconstruction.
• Axillary and internal mammary vessels are common recipient sites, but can be compromised by radiation or prior surgery.
• Alternative perfusion strategies are needed when standard recipient vessels are challenging to access or unavailable.

Purpose of the Study:

• To evaluate the efficacy of using the thoracodorsal artery (TDA) via retrograde flow as a recipient vessel system for abdominal perforator flaps in microsurgical breast reconstruction.
• To present a novel approach for breast reconstruction in patients with compromised axillary vessels.

Main Methods:

• A series of 7 microsurgical breast reconstructions using abdominal perforator flaps were performed between January 2021 and February 2023.
• Flap perfusion was achieved using retrograde flow from the thoracodorsal artery (TDA).
• This technique was employed when axillary vessels were compromised or unavailable, and the TDA had been divided.

Main Results:

• The reverse-flow TDA technique proved successful in all 7 cases, demonstrating its viability as an alternative perfusion strategy.
• This method provided a reliable option for flap perfusion when standard recipient vessels were unavailable or compromised.
• The TDA served as a valuable recipient vessel, even when previously divided.

Conclusions:

• Reverse-flow TDA perfusion is a valuable alternative strategy for microsurgical breast reconstruction, especially in challenging anatomical scenarios.
• This technique expands options for surgeons dealing with compromised or unavailable recipient vessels.
• The reverse-flow TDA offers potential for flap reperfusion in revision surgeries and after failed revascularization attempts.