title: Comparison of clinical outcomes between single- and multiple-perforator-based free thoracodorsal artery perforator flaps: clinical experience in 87 patients.
abstract: BACKGROUND
  Although thoracodorsal artery perforator flaps have not gained popularity in the reconstructive era, the results of recent studies regarding the vascularity of thoracodorsal artery perforator flaps are promising. In the present study, the authors aimed to determine the clinical outcomes of free multiple-perforator versus single-perforator thoracodorsal artery perforator flaps.
  
  
  METHODS
  Eighty-seven patients with various defects underwent reconstruction with free thoracodorsal artery perforator flaps. The flap was used for upper extremity reconstruction in 43 patients (49.4 percent), for head and neck reconstruction in 16 patients (18.4 percent), and for lower extremity reconstruction in 28 patients (32.2 percent). Of the 87 flaps, 48 (55.2 percent) were based on a single perforator, whereas 39 flaps (44.8 percent) were based on multiple perforators. The single- and multiple-perforator-based thoracodorsal artery perforator flaps were compared regarding clinical outcomes and morbidity.
  
  
  RESULTS
  The morbidity rate was found to be significantly higher in the single-perforator-based group. Of the patients in the single-perforator group, seven patients had transient venous congestion, five were heparinized and treated with leeches for permanent venous congestion, six had partial necrosis, and one had total necrosis. In the multiple-perforator-based group, two patients had transient venous congestion, and no partial or total necrosis was observed.
  
  
  CONCLUSIONS
  Despite the fact that dominant perforators may often be absent, this study showed that a multiple-perforator-based thoracodorsal artery perforator flap may be more reliable with safe vascularity compared with a single-perforator-based flap.
authors.affiliation: Istanbul, Bursa, Diyarbakir, and Manisa, Turkey From the Department of Reconstructive and Aesthetic Surgery, Microsurgery, Faculty of Medicine, Bezmialem Vakif University; private practice; and the Departments of Plastic and Reconstructive Surgery of Dicle University Faculty of Medicine, Celal Bayar University Faculty of Medicine, Istanbul University Cerrahpasa Medical Faculty, Bakirkoy Acibadem Hospital, University of Acibadem, and Bezm-i Alem Valide Sultan Vakif Gureba Training and Research Hospital.
authors.forename: Mehmet Veli
authors.initials: MV
authors.lastname: Karaaltin
authors.forename: Adnan
authors.initials: A
authors.lastname: Erdem
authors.forename: Samet
authors.initials: S
authors.lastname: Kuvat
authors.forename: Günay
authors.initials: G
authors.lastname: Çavdar
authors.forename: Hakan
authors.initials: H
authors.lastname: Kerem
authors.forename: Semih
authors.initials: S
authors.lastname: Baghaki
authors.forename: Halil İbrahim
authors.initials: Hİ
authors.lastname: Canter
authors.forename: Azimet
authors.initials: A
authors.lastname: Özdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000628:therapy; D024763:Leeching; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D006493:Heparin