Pedicled thoracodorsal arterial perforator flap for reconstruction of a large defect post-burn in posterior side of the arm

Abstract

Recently the efforts made to diminish the morbidity of the flap donor area, as well as thickness, have promoted the study and description of perforator flaps. The latissimus dorsi musculocutaneous flap has been for many years a fundamental weapon in the reconstruction of major local defects (including breast surgery) and at a distance in its free transferred state. Undoubtedly, the sacrifice of a muscle as important as the lattissimus dorsi, as well as the resulting thickness of the above mentioned flap, has made us reflect on its use because of the associated morbidity. Variations on design with the objective of diminishing thickness have lessened considerably sequelae of the donor area. From the original description by Angrigiani et al. [1] and subsequently by Spinelli et al. [2], the thoracodorsal artery perforator flap (TAP) has meant a radical change in the morbidity of the donor area, with a series of additional advantages, that include an especially large vascular pedicle, a homogeneous thinning of the flap and the conservation of the functions of the subjacent muscle [3]. Additionally, the possibility of raising up flaps of large dimensions for the reconstruction of great defects and the need to avoid deformity of the posterior axillary fold (in keeping with preservation of the innervation of the dorsal muscle), has made the TAP flap process of reconstruction far superior to other fasciocutaneous or cutaneous flaps of the same region, such as the scapular and the parascapular flaps. We illustrate a case of traumatic entrapment of the arm resulting in the loss of a considerable volume of tissue in the posterior face (21 cm × 8 cm in size), reconstructed using a TAP pedicle flap. The results as well as regularization and