1、ContentHistory and DevelopmentDefinition and FeaturesAnatomyClinical applicationMeritsShortcomingsContentHistory and DevelopmentHistory1989 Koshima perforator flap1995 Angrigiani Trunk Perforator Flap(First report).Named latissimus dorsi flap without muscleKim, Koshima called it thinning latissimus

2、dorsi flap2003 Heitmann thoracodorsal artery perforatator flap(TDAP).Firstly namedHistory1989 Koshima perforatoDefinitionThrough the latissimus dorsi thoracodorsal artery perforator,only containing skin and fascia superficialis axial pattern skin flap.DefinitionThrough the latissimFeaturesCutting fl

3、ap in deep fascia;Reserve latissimus dorsi, no damage nervi thoracodorsalis;Direct suture of the donor site within 7-10cm.FeaturesCutting flap in deep fApplied anatomyThere were 3 to 6 perforators off the distal main thoracodorsal and/or its lateral branch which constitute the vascular supply of the

4、 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 m

5、uscle to supply the overlying skin. Each perforating artery was 0.30.6 mm in diameter and accompanied by two venae comitans.Applied anatomyThere were 3 toFig.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 in

6、dicates 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 twoadjacent perforato

7、rs (TA-1 and TA-2). C,Angiogram of the latissimus dorsi muscle with the thoracodorsal arteryFig.1 A ,Angiogram of the inte胸背動脈皮瓣TDAP培訓課件 Clinical Anatomic Atlas of Microsurgery Clinical Anatomic Atlas of Clinical Anatomic Atlas of Microsurgery Clinical Anatomic Atlas of Clinical Anatomic Atlas of Mi

8、crosurgery Clinical Anatomic Atlas ofClinical applicationPedicle graftingFree graftingClinical applicationPedicle grPedicle grafting Repairing the wounds of homonymy breast ,neck,upper arm, shoulder and back, even breast reconstructionPedicle graftingFree graftingExtremities woundTrunk woundHead and

9、 neck defectsFree graftingExtremities wounFig: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

10、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

11、 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 Tho

12、racodorsal Artery Perforator Flaps: A Clinical Experience with 99 Patients.Plast Reconstr Surg,2008,121(5):1632-1641.Fig:Acase of sarcomaonthe leftKoshima I,et al.New thoracodorsal artery perforator (TAPcp) flap with capillary perforators for reconstruction of upper limb.J Plast Reconstr Aesthet Sur

13、g,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.

14、 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.Koshima I,et al.New thoracodorMeritsBlood supply is reliable, and vascular pedicle is long.It Can be achieved free tra

15、nsplantation 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 second

16、ary 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.MeritsBlood supply is reliableShortcomingsSurgery risky:Difficulty Preoperative localization，Non-constant diameter and position，Demand more microtechnique,Shortco