Thinned Thoracodorsal Perforator-Based Cutaneous Free Flap

Noh, Bok Kyun; Kim, Kwang Seog; Kim, Dae Young; Lee, Sam Yong; Cho, Bek Hyun

Abstract

The latissimus dorsi has been used as an excellent donor site for free flap because of many advantages such as reliable anatomy, long pedicle with large-caliber vessels, easiness of dissection, and minimal functional deficit of the donor site. It is also one of the most versatile free flaps due to its carrying skin, muscle, and bone components. Nevertheless, bulkiness limits its use for resurfacing the defect in thin regions such as hand, foot, and anterior tibial area. To reduce its excessive volume when bulk is considered a disadvantage, surgical modifications were introduced: muscle sectioning, reduced musculocutaneous flap, muscle splitting, and thoracodorsal perforator-based cutaneous flap. Although the thoracodorsal perforator-based cutaneous flap excluding muscle component is thinner than others, it also needs secondary debulking procedures to resurface the thin regions. Thinning of the cutaneous flap was successfully performed in paraumbilical perforator-based flap and anterolateral thigh flap. These thinned flaps depend for their circulation on the subdermal plexus originating from their pedicled vessel. Based on their survival concept, we made the thoracodorsal perforator-based cutaneous flap thin and clinically applied it to 7 patients as a free flap. They were all survived and there was no need for secondary debulking procedures. This flap adds the advantage of little bulkiness to the conventional latissimus dorsi flap. However, it has some disadvantages such as technical difficulties in dissection of the perforator, anatomical variation in the location of the perforator, and nonsensory flap.