title: Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators.
abstract: BACKGROUND
  The thoracodorsal artery perforator flap with capillary perforators (TAPcp) is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can overcome the drawbacks of the conventional TAP flap, which results in anatomical variations due to the presence of a dominant muscle or septocutaneous perforators. We applied color Doppler ultrasonography (US) to preoperatively visualize capillary perforators of the descending branch of thoracodorsal artery to facilitate successful flap elevation.
  
  
  METHODS
  Using preoperative color Doppler US, we examined seven flaps in seven patients who had undergone reconstruction with TAPcp flaps between January 2014 and April 2015. Capillary perforators with diameters <0.5 mm were identified in the anterior border of the latissimus dorsi (LD) muscle. Perforator courses and their penetration points were marked to guide dissection.
  
  
  RESULTS
  All seven TAPcp flaps were successfully harvested without pedicle damage or perfusion disorders. No serious postoperative complications occurred such as total necrosis or absorption of the transferred adipose flap. In all seven cases, capillary perforators and the descending branch of the thoracodorsal artery were found almost exactly where the preoperative color Doppler US was targeted.
  
  
  CONCLUSIONS
  Using the technique described herein, capillary perforators of the descending branch of the thoracodorsal artery are easily visualized, and TAPcp flaps can be easily used for various kinds of reconstruction. Moreover, this technique is quick and safe to administer.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: tashirox@gmail.com.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Tashiro
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Araki
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002196:Capillaries / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D035441:Thoracic Wall / Q000098:blood supply; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
keywords: Color Doppler ultrasonography; Perforator flap; Supermicrosurgery; TAP flap; TAPcp flap; Thoracodorsal artery perforator