Transverse thoracodorsal artery perforator flaps: experience with 31 free flaps

The conventional design of free thoracodorsal artery perforator (TDAP) flaps is orientated vertically along the long axis of the latissimus dorsi muscle, i.e. along the course of the descending branch of the thoracodorsal artery. However, this method does not consider perforators derived from the transverse branch of the thoracodorsal artery, and leaves a long scar that runs perpendicular to the relaxed skin tension line. Accordingly, scar widening and hypertrophy are frequently encountered problems. From April 2004 to December 2005, 31 free TDAP flap transfers were performed in 29 patients for reconstruction of the lower extremity (16 flaps), head and neck (12 flaps), and upper extremity (three flaps). Flap long axes were laid transversely following the relaxed skin tension line and paddles were designed to include proximal perforators from both branches of the thoracodorsal artery. Flap sizes ranged from 7 × 5 cm to 22 × 12 cm with a mean thickness of 7.5 mm (range 3-13 mm). Among the 40 perforators employed as pedicles, 34 were derived from the descending branch and six were from the transverse branch of the thoracodorsal artery. Except for a single case of total flap loss, the other flaps were successfully transferred. Donor scars ranged from 6 to 28 mm in width after a minimum follow-up period of 10 months. The transverse design may be preferred whilst planning free TDAP flap transfer, because the surgeon has a wider choice of perforators and the final donor scar has a less disfiguring appearance.