Thoracodorsal Artery Perforator Flap for Reconstruction

The perforator flaps for breast reconstruction have been used at Louisiana State University Medical Center since 1992. The most common flaps used are those taken from the abdomen or buttocks based on the deep inferior epigastric perforators or the gluteal artery perforators, respectively. Perforator flaps have also been taken from the lateral thigh or saddlebag area to be used for breast reconstruction. The perforator flaps used as free flaps have been shown to be an attractive alternative to musculocutaneous flaps in that they afford complete muscle sparing and should lessen any complications previously noted to be caused by the harvesting of muscle (de, abdominal wall hernia, etc).

We have used perforator flaps based on the thoracodorsal artery perforators. This allowed the harvesting of a large paddle of skin and fat from the back without sacrifice of the latissimus dorsi muscle. Research methods included cadaver dissections and Doppler blood flow studies of the thoracodorsal artery. We have had success in five clinical cases using T-DAP flap for breast reconstruction, chest wall, and axillary and distal wound coverage. We had one failure due to poor venous outflow.