Thoracodorsal Artery Perforator Flap

Overview

• Utilizes a skin paddle above the latissimus dorsi muscle.
• Supplied by a myocutaneous perforator from the descending branch of the thoracodorsal pedicle.
• The pedicle runs along the deep surface of the muscle.

Harvest Procedure

Initial Steps

• Incision: Begins at the axilla, tracing the anterior border of the latissimus dorsi muscle.
• Dissection: As the muscle is revealed, care is taken to continue along the anterior border to prevent injury to the perforator.

Identifying Structures

• Perforator Location: Found ~2 cm from the anterior border of the muscle.
• Muscle Separation: Latissimus dorsi muscle is dissected away from the serratus anterior muscle.
• Nerve Preservation: Long thoracic nerve located anterior to the serratus anterior branch is preserved.

Pedicle Identification

• Thoracodorsal Pedicle: Dissection proceeds towards axilla to reveal the thoracodorsal pedicle.
• Descending Branch: Identified along with the nerve to the latissimus dorsi, which is preserved.

Flap Mobilization

• Perforator Dissection: Followed through muscle to pedicle, dividing overlaying muscle, medial branch, and serratus anterior branch.
• Skin Paddle Marking: Posterior border marked and traced with electrocautery.
• Dissection: Paddle dissected away from muscle, leaving a safe margin around the perforator.
• Pedicle Division: Descending branch divided distal to perforator; perforator lifted from muscle.
• Final Steps: Proximal thoracodorsal pedicle divided, fully mobilizing the flap.