title: Reliable harvesting of a large thoracodorsal artery perforator flap with emphasis on perforator number and spacing.
abstract: BACKGROUND
  Thoracodorsal artery perforator flaps are useful for covering extensive defects because of their generous donor-site dimensions. However, large flaps increase the risk of partial flap necrosis, and a reliable means of sizing thoracodorsal artery perforator flaps has not been devised. The authors reviewed a series of large thoracodorsal artery perforator flap transfers performed under various reconstructive conditions to evaluate surgical outcomes and placed emphasis on flap design and harvesting technique.
  
  
  METHODS
  A consecutive series of large thoracodorsal artery perforator flaps (>20 cm long) performed between November of 2005 and March of 2010 were included in this study. Patient charts, operative records, and photographs were reviewed.
  
  
  RESULTS
  A total of 20 flaps with an average size of 25 × 11 cm in 20 patients were identified; the largest flap measured 32 × 13 cm. The average number of perforators included was 2.6 per flap (range, one to four). Four different harvesting techniques were used, depending on perforator numbers and locations. All large flaps survived without sizable partial flap necrosis. Complications included wound dehiscence in one donor and two recipient sites; all healed after wound repair. Tip necrosis of a small area developed but healed with conservative wound care.
  
  
  CONCLUSIONS
  This study reports the clinical safety of large thoracodorsal artery perforator flaps with customized thickness control, which can be reliably harvested beyond 20 cm in length by carefully considering perforator numbers and locations. To optimize tissue perfusion in these large flaps, effort is required to capture multiple perforators from various sources and to obtain an ideal arrangement.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Seoul, South Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Hwang
authors.forename: So-Young
authors.initials: SY
authors.lastname: Lim
authors.forename: Jai-Kyong
authors.initials: JK
authors.lastname: Pyon
authors.forename: Sa-Ik
authors.initials: SI
authors.lastname: Bang
authors.forename: Kap-Sung
authors.initials: KS
authors.lastname: Oh
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008866:Microsurgery / Q000379:methods*; D055806:Microvessels / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods; D036542:Tomography, Spiral Computed; D055815:Young Adult