Clinical application of the modified thoracodorsal artery perforator flap

Objective:To investigate the clinical application of the modified thoracodorsal artery perforator flap with partial muscle around vascular pedicle.Methods:Eleven cases treated with modified thoracodorsal artery perforator flaps were applied.The distribution and location of the main perforator vessels of thoracodorsal artery lateral branches were explored using Doppler flowmetry before operation.The perforator vessels with 3 to 5cm muscle in width were separated,and the modified flap with most partial latissimus dorsi muscle and thoracodorsal nerve was designed.The donor area was repaired with skin-grafting or direct suturing.The near transferring of ipsilateral vascular pedicle in 4 cases and free grafting in 11 cases were applied.Results:One case necrosed after vascular crisis,and other 10 cases survived.The largest and smallest area of the flaps were 22 cm×15 cm and 8 cm×5 cm,respectively.During the following up of 6 to 24 months,the blood supply and texture of flaps were fine.Except the repairing of the foot wound was slightly overstaffed,other appearances were good.The donor site was hidden,and has obvious scars.The dysfunction of latissimus dorsi was not found.Conclusions:The perforator vessel of thoracodorsal artery can be located by Doppler flowmetry before operation.The anatomical position of the perforator vessel of thoracodorsal artery is relatively constant,the cutting of modified flap with partial muscle around perforator is convenient,and the survival rate of which is high.