胸背动脉皮瓣(TDAP).ppt

胸背动脉皮瓣(TDAP).ppt

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ThoracodorsalArteryPerforatatorFlapDepartmentofBurnandPlasticSurgery,AffiliatedHospitalofZunyiMedicalCollegeContentHistoryandDevelopmentDefinitionandFeaturesAnatomyClinicalapplicationMeritsShortcomingsHistory1989Koshimaperforatorflap1995AngrigianiTrunkPerforatorFlap（Firstreport）.NamedlatissimusdorsiflapwithoutmuscleKim,Koshimacalleditthinninglatissimusdorsiflap2003Heitmannthoracodorsalarteryperforatatorflap（TDAP）.FirstlynamedDefinitionThroughthelatissimusdorsithoracodorsalarteryperforator,onlycontainingskinandfasciasuperficialisaxialpatternskinflap.FeaturesCuttingflapindeepfascia;Reservelatissimusdorsi,nodamagenervithoracodorsalis;Directsutureofthedonorsitewithin7-10cm.AppliedanatomyTherewere3to6perforatorsoffthedistalmainthoracodorsaland/oritslateralbranchwhichconstitutethevascularsupplyofthethoracodorsalarteryperforatorflap.Thefirstperforatorwaslocatedapproximately68cmbelowtheposterioraxillaryfold.Subsequentperforators,uptoatotalofthree,arisedat1.54cmintervalsinferiorlyoffthelateralbranch.Eachperforatordisplayeda35cmobliquecoursethroughthemuscletosupplytheoverlyingskin.Eachperforatingarterywas0.30.6mmindiameterandaccompaniedbytwovenaecomitans.Fig.1A,Angiogramoftheintegumentofthechestandupperbackfromahumancadaverleadoxideandgelatininjectionspecimen.Theblacklineindicatesanoutlineofthelatissimusdorsi.B,Thedesignofthethoracodorsalarteryperforatorflap.Thereliablesizeofthethoracodorsalarteryperforatorflapthatcanbeelevatedonasingleperforator（TA-1）was158cm.Themaximumflapupto25cm12cmwasharvestedontwoadjacentperforators（TA-1andTA-2）.C,AngiogramofthelatissimusdorsimusclewiththethoracodorsalarteryClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasofMicrosurgeryClinicalapplicationPediclegraftingFreegraftingPediclegraftingRepairingthewoundsofhomonymybreast,neck,upperarm,shoulderandback,evenbreastreconstructionFreegraftingExtremitieswoundTrunkwoundHeadandneckdefectsFig:

Acaseofsarcomaontheleftshoulderofa56-year-oldman.（Above,left）Acompound（chimera）flapisdesigned.Theflapconsistsofathoracodorsalarteryperforatorflapwithasegmentoflatissimusdorsimuscletoreconstructthedeltoidmusclebecauseoftumorresection.（Above,right）Thelatissimusdorsisegment（10-5cm）wasdissectedwithavascularpedicleindependentofthepedicleofthethoracodorsalarteryperforatorflap（arrow）.（Below,left）Themusclesegmentiselevated.Theperforatorarisesfromthehorizontalbranchandcoursesunderthethoracodorsalnervebranch（twoarrows）toentertheskinpaddle（vesselloopandarrow）.（Below,right）Thethoracodorsalarteryperforatorflapispassedunderthethoracodorsalnervethatisleftintacttotherestofthelatissimusdorsimuscle.HamdiM,etal.SurgicalTechniqueinPedicledThoracodorsalArteryPerforatorFlaps:

AClinicalExperiencewith99Patients.PlastReconstrSurg,2008,121（5）:

1632-1641.KoshimaI,etal.Newthoracodorsalarteryperforator（TAPcp）flapwithcapillaryperforatorsforreconstructionofupperlimb.JPlastReconstrAesthetSurg,2010,63

（1）:

140-145.Fig:

（A）A73-year-oldwomanwithwidelyinvadedskincanceronradiatedrighthand.Entiredorsalandpalmarskinwasresected.（B）TAPflaponleftlateralthoracicregioninsupineposition.（C）ObtainedTAPflapwiththelateraldescendingbranch.（D）Schemaofreconstruction.Metacarpalboneofindex（M）wastransferredtocreateathumb.Thethoracodorsalartery（T）wasinterposedintoradialarteryinaflow-throughfashion.（E）Oneyearaftersurgery.MeritsBloodsupplyisreliable,andvascularpedicleislong.ItCanbeachievedfreetransplantationorwithapedicletransfertorepairthetrunkofthelimbs,butalsoforbreastreconstructionandrepairofmaxillofacialdefects.Thedonorsiteishiddenandcanbedirectlysutured.Thefunctionandthebeautyofthedonorareaaresmall.Flapthicknessuniformity,rarelyoccursecondaryoperationbloated.BasedonrepairneedcutthechimericorleafTDAPowingtodiversityofoperation.Kepttheintegrityoflatissimusdorsiandnervithoracodorsalis.Didnotaffactmovementfunctionofthelatissimusdorsi.Lesscomplicationofdonorsite.ShortcomingsSurgeryrisky:

DifficultyPreoperativelocalization，Non-constantdiameterandposition，Demandmoremicrotechnique,Prolongedoperationtime:

ChangepositionDonorandrecipientcantsimultaneouslyoperateOthers:

myocutaneousarteryperforatorabsentormutatelimitedflapwidth7-10cmeffectingnormalbreastposition（female）