Angiographic Observation of the Perforators of Thoracodorsal Artery and Application of the Perforator Flaps in Repairing Adjacent Wounds.

OBJECTIVE

The thoracodorsal artery perforator flap has not been widely used in clinical practice partly due to a lack of imaging evidence. The authors aim to investigate the types of thoracic dorsal artery perforators through angiography and provide our experiences in the utilization of thoracic dorsal artery perforator flaps to repair adjacent wounds.

METHODS

This study was divided into two parts. The first part was an angiography of the thoracodorsal artery in 12 patients based on DSA and CTA images from January 2015 to December 2023. The branches and perforators of the thoracodorsal artery were observed and classified. The second part study, between January 2019 and December 2023, illustrated the clinical application of thoracodorsal artery perforator flap in repairing neighboring wounds in 10 cases where a small area of muscular vascular pedicle was preserved with oblique branch of thoracodorsal artery trunk dissected to extend the pedicle. The donor area of the flap was closed primarily. The patients were followed up to evaluate the functional recovery of the shoulder joint after operation.

RESULTS

The perforators of thoracodorsal artery were classified into 2 types based on the number and diameter: type I, the dominant perforating type (1-2 dominant perforators plus varying numbers of tiny perforators); and type II, the capillary perforating type (a larger number of tiny perforators without dominant perforators). The diameter of the dominant perforator is >0.5 mm, while the diameter of the capillary perforators is <0.5 mm. In the first part of the study, there were 8 cases of dominant perforating type and 4 cases of capillary perforating type. In the second part of the study, 10 cases of thoracodorsal artery perforator flaps were applied to repair the chest wall (3 cases), the back (1 case), the axilla (2 cases), the shoulder (2 cases) and the upper arm (2 cases). All the flaps fully survived with no complications, such as hematoma and seroma in the donor area. The function of the shoulder joint was not affected in these patients.

CONCLUSIONS

The angiography showed that thoracodorsal artery perforators could be categorized into 2 types, namely the dominant perforators and capillary perforators. The thoracodorsal artery perforator flap with a small area of muscular vascular pedicle can be harvested with blood supply from both types of perforators. With reliable blood supply, flexible selection of tissue volume and minimal muscle injury, it becomes a good choice for repairing wounds on the thoracic-dorsal-shoulder area.