胸背动脉皮瓣(TDAP)

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Thoracodorsal Artery Perforatator Flap,Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical College,Content,History and,D,evelopment,Definition and Features,Anatomy,Clinical application,Merit,s,Shortcomings,History,1989 Koshima perforator flap,1995 Angrigiani Trunk Perforator Flap(First report).Named latissimus dorsi flap without muscle,Kim,Koshima call,ed it,thinning latissimus dorsi flap,2003 Heitmann thoracodorsal artery perforatator flap(TDAP).Firstly named,Definition,Through the latissimus dorsi thoracodorsal artery perforator,only containing skin and fascia superficialis axial pattern skin flap.,Features,Cutting flap in deep fascia;,Reserve latissimus dorsi,no damage nervi thoracodorsalis;,Direct suture of the donor site within 7-10cm.,Applied anatomy,There were 3 to 6 perforators off the distal main thoracodorsal and/or its lateral branch which constitute the vascular supply of the thoracodorsal artery perforator flap.The first perforator was located approximately 68 cm below the posterior axillary fold.Subsequent perforators,up to a total of three,arised at 1.54 cm intervals inferiorly off the lateral branch.Each perforator displayed a 35 cm oblique course through the muscle to supply the overlying skin.Each perforating artery was 0.30.6 mm in diameter and accompanied by two venae comitans.,Fig.1 A,Angiogram of the integument of the chest and upper back from a human cadaver lead oxide and gelatin injection specimen.The black line indicates an outline of the latissimus dorsi.B,The design of the thoracodorsal artery perforator flap.The reliable size of the thoracodorsal artery perforator flap that can be elevated on a single perforator,(TA-1)was 15 8 cm.The maximum flap up to 25 cm 12 cm was harvested on two,adjacent perforators(TA-1 and TA-2).C,Angiogram of the latissimus dorsi muscle with the thoracodorsal artery,Clinical Anatomic Atlas of Microsurgery,Clinical Anatomic Atlas of Microsurgery,Clinical Anatomic Atlas of Microsurgery,Clinical application,Pedicle graft,ing,Free grafting,Pedicle graft,ing,Repairing the wounds of homonymy breast,neck,upper arm,shoulder and back,even breast reconstruction,Free grafting,Extremities wound,Trunk wound,Head and neck defects,Fig:,Acase of sarcomaonthe left shoulder of a 56-year-old man.(Above,left)Acompound(chimera)flap is designed.The,flap consists of a thoracodorsal artery perforator flap with a segment of latissimus dorsi muscle to reconstruct the deltoid,muscle because of tumor resection.(Above,right)The latissimus dorsi segment(10,-,5 cm)was dissected with a vascularpedicle independent of the pedicle of the thoracodorsal artery perforator flap(arrow).(Below,left)The muscle segment is,elevated.The perforator arises from the horizontal branch and courses under the thoracodorsal nerve branch(two arrows)to enter the skin paddle(vessel loop and arrow).(Below,right)The thoracodorsal artery perforator flap is passed under thethoracodorsal nerve that is left intact to the rest of the,latissimus dorsi muscle.,Hamdi M,et al.Surgical Technique in Pedicled Thoracodorsal Artery Perforator Flaps:A Clinical Experience with 99 Patients.Plast Reconstr Surg,2008,121(5):1632-1641.,Koshima I,et al.New thoracodorsal artery perforator(TAPcp)flap with capillary perforators for reconstruction of upper limb.J Plast Reconstr Aesthet Surg,2010,63(1):140-145.,Fig,:,(A)A 73-year-old woman with widely invaded skin cancer on radiated right hand.Entire dorsal and palmar skin was,resected.(B)TAP flap on left lateral thoracic region in supine position.(C)Obtained TAP flap with the lateral descending branch.,(D)Schema of reconstruction.Metacarpal bone of index(M)was transferred to create a thumb.The thoracodorsal artery(T)was,interposed into radial artery in a flow-through fashion.(E)One year after surgery.,Merits,Blood supply is reliable,and vascular pedicle is long.It Can be achieved free transplantation or with a pedicle transfer to repair the trunk of the limbs,but also for breast reconstruction and repair of maxillofacial defects.,The donor site is hidden and can be directly sutured.The function and the beauty of the donor area are small.,Flap thickness uniformity,rarely occur secondary operation bloated.Based on repair need cut the chimeric or leaf TDAP owing to diversity of operation.,Kept the integrity of latissimus dorsi and nervi thoracodorsalis.Did not affact movement function of the latissimus dorsi.Less complication of donor site.,Shortcomings,Surgery risky:,Difficulty Preoperative localization,，,Non-constant diameter and position,，,Demand more microtechnique,Prolonged operation time:,Change position,Donor and recipient cant simultaneously operate,Others:,myocutaneous artery perforator absent or mutate,limited flap width 7-10cm,effecting normal breast position(female),