Modified Free Latissimus Dorsi-Thoracodorsal Artery Perforator Flap for Resurfacing Extensive Soft Tissue Defect-A Case Report

Abstract

The thoracodorsal artery perforator flap is a versatile flap for resurfacing of various soft tissue defects. For resurfacing extensive defects, authors advocated combined (or chimeric) latissimus dorsi-thoracodorsal artery perforator flaps. The patient is a 7 years old boy who sustained an extensive circumferential soft tissue defect at his right foot and ankle. We used color Doppler songraphy to evaluate the course of thoracodorsal artery and its skin perforators preoperatively. Only a tiny (about 0.3 mm in diameter) skin perforator derived from the descending branch of thoracodorsal artery was detected. To protect the fragile perforator, the deep fascial plane around the perforator was not dissected, and intramuscular dissection for releasing the perforator was not done. The skin paddle was rotated over the proximal attachment between the skin flap and the muscle bulk, which contained the skin perforator. Accordingly, the flap could resurface an extensive soft tissue defect. Preoperative color Doppler sonogrphy can identify the exact location, estimate the size, and measure the blood flow rate of a skin perforator. It does facilitate the flap elevation, and prevent injury to skin perforators.