title: Different types of suprafascial courses in thoracodorsal artery skin perforators.
abstract: BACKGROUND
  The thoracodorsal artery perforator flap is a versatile flap for resurfacing soft-tissue defects. However, it is too bulky for resurfacing shallow defects. The authors used preoperative color Doppler sonography to identify the suprafascial courses of skin perforators to facilitate the design and thinning procedures of thoracodorsal artery perforator flaps.
  
  
  METHODS
  Thin thoracodorsal artery perforator flaps were designed in 29 patients. Preoperative color Doppler sonography was used to identify the penetrating points and suprafascial courses of skin perforators. According to the different orientations of suprafascial courses, skin perforators could be classified into three types. The designs and thinning procedures of flaps relied on the findings of preoperative color Doppler sonography.
  
  
  RESULTS
  Fifty-eight ideal perforators were marked on the 29 patients. Intraoperative dissections proved that 55 perforators were thoracodorsal artery skin perforators, and three perforators were intercostal artery perforators. In one patient, no skin perforator derived from the descending branch of the thoracodorsal artery was found during intraoperative dissection (3.4 percent). Suprafascial courses could be demonstrated by preoperative color Doppler sonography in 54 of the 55 thoracodorsal artery skin perforators. Nineteen were type 1 perforators (35.2 percent), 26 were type 2 perforators (48.1 percent), and nine were type 3 perforators (16.7 percent). Complications were encountered in six patients (20.7 percent), all of whom recovered well.
  
  
  CONCLUSIONS
  The suprafascial courses of skin perforators facilitate the design and thinning procedures of thoracodorsal artery perforator flaps. They improve the survivability of flaps and make thinning procedures more secure and efficient.
authors.affiliation: Tainan, Kaohsiung, and Taipei, Taiwan From the Division of Plastic and Reconstructive Surgery, Yong-Kang Veterans Hospital; Department of Radiology and Division of Plastic and Reconstructive Surgery, 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: Kuei-Chang
authors.initials: KC
authors.lastname: Hsu
authors.forename: Kuo-Chung
authors.initials: KC
authors.lastname: Yang
authors.forename: Jin-Shyr
authors.initials: JS
authors.lastname: Chen
authors.forename: Lee-Wei
authors.initials: LW
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D001415:Back; D002648:Child; D005205:Fascia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012867:Skin / Q000098:blood supply* / Q000000981:diagnostic imaging; D013524:Surgical Flaps / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color; D014947:Wounds and Injuries / Q000601:surgery*