Septocutaneous thoracodorsal artery perforator flaps: a retrospective cohort study

Publication date: Available online 5 September 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Shimpei Miyamoto, Masaki Arikawa, Yu Kagaya, Yutaka Fukunaga

Abstract

Background

This study aimed to investigate the versatility of septocutaneous thoracodorsal artery perforator flaps in various areas in the body and the running pattern of septocutaneous perforators.

Methods

This retrospective cohort study included 20 consecutive patients who underwent reconstruction of an oncology-related defect with a septocutaneous thoracodorsal artery perforator flap from May 2014 to January 2018. Fifteen flaps were free and the other five were pedicled. Surgical details and postoperative complications were investigated.

Results

The flap size ranged from 13 × 6.5 to 22 × 15 cms. The defect location was the upper extremity in eight patients, the head and neck in six, the lower extremity in four, and the trunk in two. The septocutaneous perforator arose from the thoracodorsal vessels proximal to the serratus anterior branch in 10 (50.0%) patients, from the thoracodorsal vessels distal to the serratus anterior branch in six (30.0%), and from the serratus anterior branch in four (20.0%). All flaps completely survived, except for one with partial necrosis. The scapula was simultaneously harvested based on the angular branch in three patients who underwent mandibular reconstruction.

Conclusions

The septocutaneous thoracodorsal artery perforator flap can be a versatile option for various types of reconstruction if the dominant septocutaneous perforator is present. Prevalence of the dominant septocutaneous thoracodorsal artery perforator is estimated at approximately 50%. However, this flap can be harvested without tedious intramuscular dissection and the two-team approach is possible during tumor resection. The presence of the dominant septocutaneous perforator can expand indication of the thoracodorsal artery perforator flap.