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Razmi SE, Entezami P, Asarkar AA, Ware E, Hayden RE, Chang BA. Systematic review of the free thoracodorsal artery perforator flap for head and neck reconstruction. Am J Otolaryngol 2024; 45:104154. [PMID: 38113777 DOI: 10.1016/j.amjoto.2023.104154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The thoracodorsal artery perforator (TDAP) flap has gained interest as a option for reconstruction of head and neck defects while minimizing donor site morbidity as compared to traditional workhorse flaps. The primary aim of this systematic review is to assess the postoperative outcomes and efficacy of this flap. METHODS Several databases were screened for relevant citations. The quality of studies and risk of bias were evaluated using the MINORS scoring system. RESULTS Twenty articles containing 168 patients undergoing at least one TDAP flap reconstruction met the inclusion criteria. There were no incidences of total flap failure and only 10 incidences of partial flap failure (5.95 %). Flap complications and donor site morbidity was low. The average MINORS score of the studies suggested a moderately high amount of bias. CONCLUSIONS Based on limited quality evidence, this review suggests that TDAP flap is a safe and feasible option for head and neck reconstruction with comparable success rates as other commonly used flaps, with low complication rate and donor site morbidity. Further large-scale studies are warranted.
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Affiliation(s)
| | | | - Ameya A Asarkar
- Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Erin Ware
- Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Jaffar S, Jaiswal D, Shankhdhar VK, Bindu A, Mathews S, Mantri M, Kumar V, Yadav PS. Free Thoracodorsal Artery Perforator Flap for Head and Neck Reconstruction: An Indian Experience. Indian J Plast Surg 2023; 56:499-506. [PMID: 38105872 PMCID: PMC10721372 DOI: 10.1055/s-0043-1776361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background We describe our experience with use of free thoracodorsal artery perforator (TDAP) flap for head and neck (H&N) cancer reconstruction, with respect to the patient and disease profile, suitable defect characteristics, the reconstructive technique, and complications. Methods Consecutive patients ( N = 26) undergoing free TDAP flap for H&N onco-reconstruction, in a single center, were included from January 2015 to December 2018 and the data were analyzed. Results Perforator(s) were reliably predicted preoperatively, using handheld Doppler. Lateral position was comfortable for the harvest. Twenty flaps were harvested on a single perforator, more commonly musculocutaneous ( n = 16). The thoracodorsal nerve and latissimus dorsi muscle could be preserved, completely in almost all cases. The skin paddle was horizontally ( n = 5) or vertically ( n = 21) oriented, both giving a satisfactory scar. The flap was used as a single island or two islands by de-epithelializing intervening skin. Pedicle length was sufficient in all cases. Four cases were explored for suspected venous insufficiency. Two had thrombosis, of which one was salvaged, while the other necrosed. One flap had minimal partial necrosis, which was managed with secondary suturing. The 5-year follow-up showed good oral competence, mouth opening, and cosmetic satisfaction among patients. Conclusion TDAP flap provides all the advantages of a perforator-based free flap and of back as a donor site with close color match to the face, relatively hairless, and thickness in between the thigh and the forearm. It can be a useful tool to provide an ideal functional and aesthetic outcome, with a hidden donor site and minimal donor site morbidity in selected cases.
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Affiliation(s)
- Samreen Jaffar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dushyant Jaiswal
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Kant Shankhdhar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Bindu
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saumya Mathews
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayur Mantri
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vineet Kumar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabha Subhash Yadav
- Department of Plastic and Reconstructive Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Girgaon, Mumbai, Maharashtra, India
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Free thoracodorsal, perforator-scapular flap based on the angular artery (TDAP-Scap-aa): Clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects. J Craniomaxillofac Surg 2019; 47:1617-1625. [DOI: 10.1016/j.jcms.2019.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/24/2019] [Accepted: 07/14/2019] [Indexed: 11/17/2022] Open
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Reconstruction of Diabetic Foot Defects With the Proximal Lateral Leg Perforator Flap. Ann Plast Surg 2019; 82:546-551. [DOI: 10.1097/sap.0000000000001745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tawa P, Foirest C, Tankéré F, Ouar N, Brault N, Atlan M, Qassemyar Q. [Tongue reconstruction by thoracodorsal perforator flap: A new harvesting technique to reduce morbidity]. ANN CHIR PLAST ESTH 2019; 64:368-373. [PMID: 30827573 DOI: 10.1016/j.anplas.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
The thoracodorsal artery perforator flap is increasingly used in head and neck reconstructions. One of its multiple advantages is the low donor site morbidity compared to the other free flaps usually used for this type of surgery, such as the radial forearm free flap and the anterolateral flap of the thigh. However, the current harvesting technique of the thoracodorsal artery free perforator flap needs a vertical incision rising high in the axillary hollow for the dissection of the pedicle, thus impeding optimal discretion of the donor site, especially for women. We describe an original technique to harvest a pure transversal skin paddle on its own perforator, leaving a horizontal scar thoroughly hidden in the bra and preserving the thoracodorsal pedicle. We detail the requirements for this new type of harvesting.
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Affiliation(s)
- P Tawa
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France
| | - C Foirest
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Tankéré
- Service d'oto-rhino-laryngologie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - N Ouar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - N Brault
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - M Atlan
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - Q Qassemyar
- Service de chirurgie plastique, reconstructrice et esthétique - microchirurgie - régénération tissulaire, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de médecine, Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Service de chirurgie plastique, reconstructrice et brûlés, hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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O'Connell JE, Bajwa MS, Schache AG, Shaw RJ. Head and neck reconstruction with free flaps based on the thoracodorsal system. Oral Oncol 2017; 75:46-53. [DOI: 10.1016/j.oraloncology.2017.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/29/2022]
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Bach C, Dreyfus J, Wagner I, Lachiver X, Guth A, Chabolle F. Comparison of radial forearm flap and thoracodorsal artery perforator flap donor site morbidity for reconstruction of oral and oropharyngeal defects in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:185-9. [DOI: 10.1016/j.anorl.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shaw R, Ho M, Brown J. Thoracodorsal artery perforator – scapular flap in oromandibular reconstruction with associated large facial skin defects. Br J Oral Maxillofac Surg 2015; 53:569-71. [DOI: 10.1016/j.bjoms.2014.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 10/17/2014] [Indexed: 11/16/2022]
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Bach CA, Wagner I, Pigot JL, Guth A, Denoux Y, Chabolle F. Velopharyngeal function after free thoracodorsal artery perforator flap in lateral and superior oropharyngeal cancer. Eur Arch Otorhinolaryngol 2014; 272:3019-26. [DOI: 10.1007/s00405-014-3279-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
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Hsu H, Chen PR, Chien SH, Lee JT. Application of Proximal Lateral Leg Perforator Flaps for Head and Neck Reconstructions. Otolaryngol Head Neck Surg 2014; 151:791-6. [DOI: 10.1177/0194599814549731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Analyze the reliability, complications, and donor site morbidity of the proximal lateral leg flap when applied to head and neck reconstruction. Study Design Case series and chart review. Setting Tertiary care teaching hospital. Subjects and Methods Nineteen patients who underwent reconstruction of various head and neck defects with this flap were analyzed. The patient demographics, flap characteristics, method of donor site closure, scars of the donor area, complication rates, as well as functional results at the recipient site were assessed. Results The flap size ranged from 4 × 4 cm to 11 × 8 cm. Vascular pedicle length ranged from 5 to 9 cm. The mean distance of the perforator from the fibula head was 9.2 cm. The mean thickness of this flap was 5.5 mm. All the donor wounds were closed primarily. The flap survival rate was 100%. Conclusion This flap has the advantages of thinness, short harvesting time, minimal donor site morbidity, and primary closure at the donor site when the flap width is less than 6 cm. This flap may be useful for reconstruction in selected patients with small and thin heads and neck defects.
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Affiliation(s)
- Honda Hsu
- Division of Plastic Surgery, Buddhist Dalin Tzu Chi Hospital, Dalin, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Peir-Rong Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Sou-Hsin Chien
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Plastic Surgery, Buddhist Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Jiunn-Tat Lee
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Plastic Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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