胸背动脉皮瓣(TDAP).ppt

Thoracodorsal Artery Perforatator Flap Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College Content History and Development Definition and Features Anatomy Clinical application Merits Shortcomings History 1989 Koshima perforator flap 1995 Angrigiani Trunk Perforator Flap(First report).Named latissimus dorsi flap without muscle Kim, Koshima called it thinning latissimus dorsi flap 2003 Heitmann thoracodorsal artery perforatator flap(TDAP).Firstly named Definition Through the latissimus dorsi thoracodorsal artery perforator,only containing skin and fascia superficialis` axial pattern skin flap. Features Cutting flap in deep fascia; Reserve latissimus dorsi, no damage nervi thoracodorsalis; Direct suture of the donor site within 7-10cm. Applied anatomy There were 3 to 6 perforators off the distal main thoracodorsal and/or its lateral branch which constitute the vascular supply of the thoracodorsal artery perforator flap. The first perforator was located approximately 6~8 cm below the posterior axillary fold. Subsequent perforators, up to a total of three, arised at 1.5~4 cm intervals inferiorly off the lateral branch. Each perforator displayed a 3~5 cm oblique course through the muscle to supply the overlying skin. Each perforating artery was 0.3~0.6 mm in diameter and accompanied by two venae comitans. Clinical application Pedicle grafting Free grafting Pedicle grafting Repairing the wounds of homonymy breast ,neck,upper arm, shoulder and back, even breast reconstruction Free grafting Extremities wound Trunk wound Head and neck defects Merits Blood supply is reliable, and vascular pedicle is long.It Can be achieved free transplantation or with a pedicle transfer to repair the trunk of the limbs, but also for breast reconstruction and repair of maxillofacial defects. The donor site is hidden and can be directly sutured.The function and the beauty of the donor area are small. Flap thickness uniformity, rarely occur secondary o