Sensate thoracodorsal artery perforator flap: a focus on its preoperative design and harvesting technique.
BACKGROUND
Free sensate thoracodorsal artery perforator flaps that include the posterior divisions of the lateral cutaneous branches of the intercostal nerves have been described. The authors used preoperative color Doppler sonography to identify the nerves and demonstrate its clinical value.


METHODS
Fourteen free sensate thoracodorsal artery perforator flaps were collected. Preoperative color Doppler sonography was used to identify the locations of thoracodorsal artery perforators and the courses of the posterior divisions of the lateral cutaneous branches of the intercostal neurovascular bundles. These posterior divisions were preserved on flaps and classified into three types. Type A and B nerves sprouted cutaneous perforating fascicles over the lateral region of the latissimus dorsi muscle. Type C nerves went through the region without any dominant perforating fascicle.


RESULTS
Twenty-one nerves were mapped, and 24 were found during surgery. The sensitivity of preoperative color Doppler sonography was 87.5 percent. Of the 24 nerves, nine were type A (37.5 percent), 12 were type B (50 percent), and three were type C (12.5 percent). Ten of the 14 patients (sensate group) showed better tactile recovery at both the center and the periphery of flap than the other 10 patients who underwent reconstruction with nonsensate flaps.


CONCLUSIONS
Preoperative color Doppler sonography is an indispensable tool for sensate thoracodorsal artery perforator flaps in locating the perforators and mapping the posterior divisions of the lateral cutaneous branches of the intercostal nerves. The information can be used to design and harvest sensate thoracodorsal artery perforator flaps, which are associated with earlier and better tactile recovery.
Lin
Cheng-Ta
CT
Kaohsiung and Taipei, Taiwan From the Division of Plastic and Reconstructive Surgery, Kaohsiung Veterans General Hospital, and National Yang-Ming University School of Medicine.
Yang
Kuo-Chung
KC
Hsu
Kuei-Chang
KC
Liu
Wen-Chung
WC
Chen
Jin-Shyr
JS
Chen
Lee-Wei
LW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011300:Preoperative Care; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting; D018615:Ultrasonography, Doppler, Color