Neurovascular anatomy of the thoracodorsal artery perforator flap for resurfacing body defect

Abstract

Objective: To determine the neurovascular anatomy of thoracodorsal artery perforator (TAP) flap for design of the thoracodorsal artery perforator (TAP) flap for resurfacing body defect and other surgical Materials and Methods: Sixty dissections of the thoracodorsal arterial system were carried out in a total of 30 preserved cadavers. The pattern of the thoracodorsal artery, nerve, cutaneous perforator of the lateral branch were studied and measured. Statistics were analyzed using SPSS computer program. Results: All cadavers, the thoracodorsal artery divided into two branches at 5 cm below the dome of axilla: the medial or the horizontal branch and the lateral or the descending branch. The medial branch was 2.2 cm from the superior border of the muscle. The lateral branch was 1.7 cm from the lateral border of the muscle. The lateral branch of the thoracodorsal artery was an average 1.3 perforators per flap (76 perforators in 60 flaps) In 100 percent of dissections, the first perforator was always the largest from this vessel system. The first perforator which measured from the dome of the axilla to its origin was 7.8 and the penetrating site to the muscle was 9.8 cm distal to the dome of the axilla. In 13 of 60 dissections, the second perforator of the thoracodorsal artery arises 3.4 cm distal to the origin of the first perforator. The third perforator was found in 3 of 60 dissections, originated 3.0 cm-from the take-off of the second perforator. The most perforators were observed to penetrate the muscle for a distance of 7 to 14 cm distal to the dome of the axilla and nearly the lateral border of the muscle. The direct cutaneous perforator originated directly from the thoracodorsal artery in 56 of 60 dissections and generally located 1.5 cm proximal to the bifurcation. The thoracodorsal nerve mostly laid lateral and superficial location to the artery. Conclusion: Center of the lap designed should be placed range of 7 to 14 cm from the dome of the axilla. This results of this anatomic study have a direct impact on flap design and very useful in a wide variety of clinical applications.