The Reconstruction of the Donor Site of DP Flap Using Thoracodorsal Artery Perforator Flap

Masayuki Okochi, Hiromi Okochi, Takao Sakaba, Kazuki Ueda, Masayuki Okochi, Hiromi Okochi, Takao Sakaba, Kazuki Ueda

Abstract

We performed a new procedure for reconstruction of donor site of a deltopectoral (DP) flap. A 58-year-old man presented with a wide subcutaneous abscess, which was caused by acute mandibular osteomyelitis due to dental caries. On admission, the patient received a neck incision for drainage. However, necrosis of the neck skin was observed after drainage. The patient had an 8 × 10 cm skin and soft-tissue defect, which we covered with a DP flap (15 × 7 cm). The DP flap donor site was reconstructed using a 16 × 8 cm pedicled thoracodorsal artery perforator (TDAP) flap. There was no flap necrosis, abscess formation, or scar contracture of the DP region. Debulking of the TDAP flap was not required. The pedicled TDAP flap is useful for the reconstruction of the donor site of DP flap. In this report, we describe our operative procedure.

Figures

Fig. 1.
Fig. 1.
An 8 × 10 cm neck skin defect was observed. A 15 × 7 cm DP flap was harvested from the left DP region. A 14 × 7 cm pedicled TDAP flap was harvested from the left lateral chest wall region. The musculocutaneous perforator (x) was identified at 9 cm from the center of axillary fossa and 1 cm posterior from the anterior border of latissimus dorsi muscle (dots).
Fig. 2.
Fig. 2.
The TDAP flap was harvested with 1 perforator.
Fig. 3.
Fig. 3.
The soft-tissue defect in the neck was repaired using a DP flap. The proximal side of the TDAP flap was fixed to the anterior shoulder region (arrow).
Fig. 4.
Fig. 4.
Postoperative view. The scarring on the DP region was aesthetically acceptable. Contracture of the anterior shoulder region was not observed.

References

    1. Bakamjian VY. A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap. Plast Reconstr Surg. 1965;36:173–184..
    1. Krijgh DD, Mureau MA. Reconstructive options in patients with late complications after surgery and radiotherapy for head and neck cancer: remember the deltopectoral flap. Ann Plast Surg. 2013;71:181–185..
    1. Sasaki K, Nozaki M, Honda T, et al. Deltopectoral skin flap as a free skin flap revisited: further refinement in flap design, fabrication, and clinical usage. Plast Reconstr Surg. 2001;107:1134–1141..
    1. Feng GM, Cigna E, Lai HK, et al. Deltopectoral flap revisited: role of the extended flap in reconstruction of the head and neck. Scand J Plast Reconstr Surg Hand Surg. 2006;40:275–280..
    1. Song B, Zhao J, Guo S, et al. Repair of facial scars by the free expanded deltopectoral flap. Plast Reconstr Surg. 2013;131:200e–208e..
    1. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995;96:1608–1614..
    1. Scaglioni MF, Chen YC, Yanko-Arzi R, et al. Upper extremity sarcoma reconstruction with a pedicle thoracodorsal artery perforator flap. J Reconstr Microsurg. 2015;31:617–620.
    1. Lee KT, Kim A, Mun GH. Comprehensive analysis of donor-site morbidity following free thoracodorsal artery perforator flap harvest. Plast Reconstr Surg. 2016;138:899–909..
    1. Kim SW, Youn S, Kim JT, et al. A modified method for harvesting thoracodorsal artery perforator flaps in a simple and time-saving approach. Microsurgery. 2016;36:642–646..

Source: PubMed

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