Jain Leena, Kumta Samir M, Purohit Shrirang K, Raut Rashmi
Department of Plastic and Reconstructive Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Indian J Plast Surg. 2015 May-Aug;48(2):153-8. doi: 10.4103/0970-0358.163051.
The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency.
We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities.
We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily.
The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.
胸背动脉穿支（TDAP）皮瓣已成为理想的穿支皮瓣之一。在此，我们描述其在适应症（游离/带蒂）、切取方法（患者体位和皮瓣方向）及穿支一致性方面的多功能性。
2014年3月至2015年2月期间，我们在单一中心共进行了6例TDAP皮瓣手术，其中5例游离皮瓣，1例带蒂皮瓣。我们的适应症包括：口腔、乳房及上下肢的重建。
我们既没有出现失败病例，也无需再次手术探查。穿支平均长度约为6 cm，通过包含胸背动脉，蒂部长度可延长至12 - 14 cm。穿支位置存在不一致性；然而，穿支的存在是确定的。它可以在侧卧位、俯卧位或仰卧位切取，因此，无需改变体位，允许采用两组团队同时进行重建手术。皮瓣可以垂直或水平方向放置，二者愈合后的瘢痕均位于不显眼的位置。除了能为四肢提供良好的颜色匹配外，该皮瓣还可进行初步的修薄。
TDAP的多功能性具有诸多优势，使其成为大多数需要软组织覆盖的重建手术的常用皮瓣。此外，切取简便使其成为初学者理想的穿支皮瓣。它与深面的背阔肌联合应用，可为覆盖和容量替代提供重建。
