Floor plan - 2013 Annual Meeting - American Association for Hand ...

Three-and Four-Dimensional Arterial and Venous Anatomies of the Thoracodorsal Artery
Perforator Flap
Institution where the work was prepared: UT Southwestern Medical Center at Dallas, Dallas, TX, USA
Michel Saint-Cyr, MD; Mark Schaverien; Gary Arbique; Spencer A Brown; Rod J Rohrich; UT Southwestern Medical
Center at Dallas
BACKGROUND:
The vascular anatomy of the thoracodorsal artery perforator flap, which has not been previously elucidated, was examined using threeand
four-dimensional computed tomographic angiography and venography.
METHODS:
Twenty-five thoracodorsal artery perforator flaps were harvested from fresh cadavers from the Western population. Dynamic static CT
angiography using iodinated contrast media was performed following cannulation of the largest perforator from the descending branch
of the thoracodorsal artery and its vena comitans in ten flaps. Imaging was repeated subsequent to flap thinning between the deep
and superficial adipose layers. Coloured latex injections and flap dissections were performed in a further fifteen flaps to establish the
location, calibre, and intramuscular length of the perforators from the thoracodorsal artery.
RESULTS:
Two distinct perforator complex types were described. Flap thinning can be safely performed between the deep and superficial adipose
layers without significantly affecting flap vascularity, provided that a safety zone about the perforator is respected. The superficial
venous system consisted of large veins arranged in a polygonal pattern situated at the subdermal level, and was connected to the deep
system by the venae comitantes of the perforators of the thoracodorsal artery. Perforators from the descending branch of the thoracodorsal
artery were found in reliable locations.
CONCLUSIONS:
Using a novel dynamic three-dimensional imaging technique, perfusion of the arterial and venous system of the throracodorsal artery
perforator flap have been elucidated. Although the flap is inherently thin, it can be safely thinned between the superficial and deep adipose
layers. This study has identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction. Figure
1. 3D static image following cannulation of the most proximal perforator from the descending branch and injection with a barium sulphate/gelatin
mixture, with illustration. Note the filling of the adjacent dorsal intercostal artery perforators via recurrent flow through the
subdermal plexus, with an absence of a suprafascial plexus. This enables the flap to be thinned without disrupting its vascular supply.
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