title: Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap.
abstract: BACKGROUND
  The thoracodorsal artery perforator flap was first introduced in 1995. Many authors focused on using anatomical landmarks to identify skin perforators and on thinning procedures for a skin paddle. In this study, we used the superthin free thoracodorsal artery perforator flap for resurfacing shallow defects of the extremities in 10 patients.
  
  
  METHODS
  Two anatomical landmarks previously presented by other authors were used for the guidance of flap elevation. The first landmark represented the site of the proximal skin perforator originating from the descending branch of the thoracodorsal artery, and the second landmark marked the site of the thoracodorsal neurovascular hilum. Ten flaps were performed, and all skin perforators originated from the descending branch of the thoracodorsal artery. The skin paddle carried only skin and the superficial adipose layer, and the largest skin paddle was 23 x 9 cm.
  
  
  RESULTS
  All defects were resurfaced with smooth contour, except for one flap in which the authors encountered flap tip superficial necrosis. The operative findings did not coincide with the first anatomical landmark in five patients. Likewise, these findings were not consistent with the second landmark in eight patients. In four patients, the thoracodorsal neurovascular hilum was located at the same level of the scapular tip or even above it. These unwanted anatomical variations increased the difficulty of exploration for skin perforators.
  
  
  CONCLUSIONS
  The thoracodorsal artery perforator flap is a feasible choice for shallow defects in superthin form. Using a color Doppler device to identify the skin perforators preoperatively is highly suggested to prevent unexpected anatomical variations.
authors.affiliation: Kaohsiung and Taipei, Taiwan From the Division of Plastic and Reconstructive Surgery and Department of Radiology, Kaohsiung Veterans General Hospital, and National Yang-Ming University School of Medicine.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Lin
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.forename: Kuo-Chung
authors.initials: KC
authors.lastname: Yang
authors.forename: Kuei-Chang
authors.initials: KC
authors.lastname: Hsu
authors.forename: Jin-Shyr
authors.initials: JS
authors.lastname: Chen
authors.forename: Lee-Wei
authors.initials: LW
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005383:Finger Injuries / Q000473:pathology / Q000601:surgery; D018409:Foot Injuries / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D013524:Surgical Flaps / Q000098:blood supply / Q000473:pathology; D013895:Thoracic Arteries / Q000601:surgery*; D018615:Ultrasonography, Doppler, Color