Thoracodorsal Artery Perforator Flap: Versatile Flap Coverage for Various Soft-Tissue Defects

The ability to provide thin and pliable soft tissue coverage and the advantageous results of underlying muscle preservation has popularized perforator flaps during the last few years. The thoracodorsal artery perforator (TAP) flap contains only skin and subcutaneous fat, and its blood supply comes from one or two perforator vessels piercing the latissimus dorsi muscle after they originate from the thoracodorsal pedicle. The aim of this study was to report clinical experience with free and pedicled transfer of TAP flaps to various soft tissue defects.

Between 2004 and 2005, 8 TAP flaps were used in 7 patients. The indications were excisional defects of axillary suppurative hydradenitis in 4 cases (bilateral involvement in one patient), breast reconstruction in 1, breast burn contracture in 1, and full-thickness cheek defect following a gunshot wound in one patient. A free perforator flap folded on itself was used to reconstruct both the skin and oral lining of the facial defect. Pedicled TAP flaps were used for small-size breast reconstruction, release of burn contracture on the breast, and axillary soft-tissue coverage after excision of severe suppurative hydradenitis. Two perforator vessels were dissected in 2 patients, and only one perforator was found to be adequate in the others. The mean flap dimensions were 8 × 20 cm and pedicle length was 19 cm.

No major complications such as vessel thrombosis, return to operating room, or flap loss were seen. Seroma, hemotoma, infection, or wound breakdown were not encountered at the flap and donor sites. Venous congestion occurred in one patient, but the flap was salvaged. All but one donor site were closed primarily. Split-thickness skin graft was used in one donor site. Enough breast mound was achieved in reconstruction of the small breast, and satisfactory aesthetic contour was provided for facial reconstruction, except a reasonable color mismatch.

The fasciocutaneous tissue in the thoracodorsal region provides a relatively thin and pliable tissue. The functional and structural integrity of the underlying muscle can be preserved when this tissue is elevated on perforator vessels. The results showed that the TAP flap is a reliable and safe flap that offers a good alternative for covering various soft tissue defects, either transferred as free or in pedicled fashion.