The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction. Issue 4 (October 2016)

• Record Type: Journal Article
• Authors: Jacobs, Jordan; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur; Tos, Tina; Siim, Elsebeth; Udesen, Ann; Hölmich, Lisbet Rosenkrantz; Salzberg, Andrew; Thomsen, Jørn Bo
• Is Part Of: Annals of plastic surgery. Volume 77:Issue 4(2016:Oct.)
• Publication Date: 2016-10
• Subjects: breast reconstruction -- mammoplasty -- breast conserving surgery -- perforator flap -- Tap -- TDAP -- Implant -- ADM -- salvage; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000000615
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Background: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP flap in reconstructive surgery. Methods: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews. Results: A total of 106 TAP flaps were performed in 97 patients. The flaps were raised with either 1 perforator (42/106), 2 perforators (55/106), or three perforators (9/106), and turned as a propeller in 99 of 106 (93%) flaps or buried as a turnover in 7 of 106 (7%) of flaps. The mean operative time was 200 minutes (range, 60–485). Major complications occurred in 10 of 106 (10%) cases and included hematoma (1/108), venous congestion (2/108), and partial flap necrosis (7/108). The reconstructive goal was achieved in 103 of 106 (97%) flaps. Conclusions: The TAP flap is a pedicled, fasciocutaneous flap that can be used for total breast reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.