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DOI: 10.1055/s-0035-1556870
Upper Extremity Sarcoma Reconstruction with a Pedicle Thoracodorsal Artery Perforator Flap
Publication History
11 December 2014
21 May 2015
Publication Date:
28 July 2015 (online)
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Soft tissue sarcomas (STS) are a rare, heterogeneous group of tumors (1% of all the malignancies). Approximately 50% of STS occur in the extremities and 30% of these are located in the upper limbs.[1] Limb preservation surgery is now the accepted standard treatment for patients with STS with less than 5% necessitating amputation. Local control of sarcoma is best achieved by adequate resection at the primary tumor stage. However, as the upper limb presents specific and unique anatomical architecture with little soft tissue, narrow compartment, and important structure in close proximity, the large defects involving this area soft tissue represent a challenging problem in reconstructive surgery.[2] [3] Although many surgical techniques are available for reconstruction of soft tissue defects of the upper arm, challenges remain in achieving a satisfactory reconstruction. Over the past few years the thoracodorsal artery perforator (TDAP) flap have been used as free flap in such area as the skull base, upper and lower extremity, or pedicle flap for reconstruction of regional defects in the trunk, head and neck, axilla, and breast.[4] [5] [6] [7] [8] Despite the increasing advances in perforator flap design and perforator imaging, there is a relative paucity of data evaluating the use of pedicle thoracodorsal artery perforator flaps in upper limb reconstruction. Here, we present (1) a brief literature review evaluating the applicability and reliability of pedicle TDAP flaps performed and (2) a case illustrating the concept of a pedicle perforator flap based on perforators arising from the thoracodorsal artery used to resurface a large wound of the antecubital fossa due to sarcoma surgery.
* Both the authors contributed equally to this work and should be consider first co-authors.
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References
- 1 American Cancer Society. What are the key statistics for sarcoma? Cancer Facts and Figures 2009. Available at: http://www.cancer.org Accessed December 1, 2014
- 2 Saint-Cyr M, Langstein HN. Reconstruction of the hand and upper extremity after tumor resection. J Surg Oncol 2006; 94 (6) 490-503
- 3 Kim JY, Subramanian V, Yousef A, Rogers BA, Robb GL, Chang DW. Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma. Plast Reconstr Surg 2004; 114 (2) 400-408 , discussion 409–410
- 4 Viñals JM, Rodrigues TA, Sildenikova DP , et al. Indications of microsurgery in soft tissue sarcomas. J Reconstr Microsurg 2012; 28 (9) 619-625
- 5 Ayhan S, Tuncer S, Demir Y, Kandal S. Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects. J Reconstr Microsurg 2008; 24 (4) 285-293
- 6 Guerra AB, Metzinger SE, Lund KM, Cooper MM, Allen RJ, Dupin CL. The thoracodorsal artery perforator flap: clinical experience and anatomic study with emphasis on harvest techniques. Plast Reconstr Surg 2004; 114 (1) 32-41 , discussion 42–43
- 7 Amin AA, Rifaat M, Ellabban MA, Zedan M, Kamel M, Bassiouny M. Transaxillary thoracodorsal artery perforator flap: a versatile new technique for hypopharyngeal reconstruction. J Reconstr Microsurg 2014; 30 (6) 397-404
- 8 Wang AW, Zhang WF, Liang F, Li JY, Zhang XF, Niu XT. Pre-expanded thoracodorsal artery perforator-based flaps for repair of severe scarring in cervicofacial regions. J Reconstr Microsurg 2014; 30 (8) 539-546
- 9 Uygur F, Kulahci Y, Sever C, Duman H. Reconstruction of postburn thenar contractures using the free thoracodorsal artery perforator flap. Plast Reconstr Surg 2009; 124 (1) 217-221
- 10 Ortiz CL, Mendoza MM, Sempere LN, Sanz JS, Torres AN, Barraquer EL. Versatility of the pedicled thoracodorsal artery perforator (TDAP) flap in soft tissue reconstruction. Ann Plast Surg 2007; 58 (3) 315-320
- 11 Sever C, Uygur F, Kulahci Y, Karagoz H, Sahin C. Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects. Indian J Plast Surg 2012; 45 (3) 478-484
- 12 Oksüz S, Ulkür E, Tuncer S, Sever C, Karagöz H. Elbow reconstruction with a pedicled thoracodorsal artery perforator flap after excision of an upper-extremity giant hairy nevus. J Plast Reconstr Aesthet Surg 2013; 66 (4) 566-569
- 13 Schwabegger AH, Bodner G, Ninković M, Piza-Katzer H. Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature. Br J Plast Surg 2002; 55 (5) 390-395