title: Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients.
abstract: BACKGROUND
  The thoracodorsal artery perforator flap is considered a technically difficult flap because of significant anatomical variations in perforator location. The authors' strategy to facilitate the harvest of these flaps includes careful preoperative mapping of perforators and a standardized planning and harvesting technique. The authors evaluated 99 pedicled thoracodorsal artery perforator flaps, with an emphasis on preoperative planning, surgical technique, and analysis of complications.
  
  
  METHODS
  Between May of 2000 and October of 2006, 99 patients underwent pedicled thoracodorsal artery perforator flaps in the authors' department. Their charts and postoperative results were reviewed retrospectively.
  
  
  RESULTS
  A thoracodorsal artery perforator flap was harvested in 90 cases. The perforators were unsuitable in the other 10 flaps; therefore, a muscle-sparing technique was used (type I or type II). Unidirectional Doppler imaging was used exclusively in 92 percent of cases to map the perforator preoperatively. The average flap size was 20 x 8 cm. Average operative time for flap harvest was 80 minutes. Perforators were located at 8 to 13 cm from the axillary crease (average, 10.8 cm). Major flap necrosis occurred in one case (1 percent). Limited partial or palpable fat necrosis occurred in three cases (3 percent). Seroma formation was not encountered in any of the thoracodorsal artery perforator flaps or muscle-sparing thoracodorsal artery perforator type I flaps.
  
  
  CONCLUSIONS
  Careful preoperative perforator mapping and a standardized approach to flap planning and harvest can significantly reduce the difficulty of executing pedicled thoracodorsal artery perforator flaps.
authors.affiliation: Gent, Belgium From the Plastic Surgery Department, Gent University Hospital.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Hamdi
authors.forename: Koenraad
authors.initials: K
authors.lastname: Van Landuyt
authors.forename: John B
authors.initials: JB
authors.lastname: Hijjawi
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roche
authors.forename: Phillip
authors.initials: P
authors.lastname: Blondeel
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla / Q000293:injuries* / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D002056:Burns / Q000601:surgery*; D004210:Dissection / Q000379:methods; D004954:Esthetics; D005260:Female; D016575:Hidradenitis / Q000601:surgery*; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D012509:Sarcoma / Q000601:surgery*; D012782:Shoulder / Q000601:surgery*; D000070599:Shoulder Injuries; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014945:Wound Healing