Reliability of eccentric position of the pedicle instead of central position in a thoracodorsal artery perforator flap

Abstract

IntroductionTo obtain longer vascular pedicle in perforator flaps, surgeons often use eccentrically rather than centrally located perforators. The aim of this study was to compare the safety and reliability of thoracodorsal artery perforator (TDAP) flaps harvested with centrally or eccentrically located perforators. MethodsBetween January 2008 and March 2012, 100 TDAP flaps were used to reconstruct the lower extremity defects. Flaps longer than 10 cm, with a single musculocutaneous perforator, and one artery-one vein anastomoses were included. The cases were divided into two groups according to perforator location; Central perforators in 60 cases (group 1), and peripheral perforators in 40 cases (group 2). Total pedicle length was between the points where the perforator enters the flap to the end of the pedicle. Real pedicle length was from flap margin to the end of the pedicle. The flap dimension, total pedicle length, real pedicle length, and flap related complications were measured. ResultsThe flaps were smaller in group 1 than in group 2 (159.694.08 vs.189.95134.30 cm(2), P=0.455). Total pedicle length was almost the same (12.12 +/- 1.57 vs.12.88 +/- 2.10 cm, P=0.420), but the mean real pedicle length was longer in group 2 (6.13 +/- 1.33 vs.11.65 +/- 2.08 cm, P<0.05). There were 4 cases of partial loss of flap in group 1 and 3 partial loss and one total flap loss in group 2 without significant difference (P=0.547). ConclusionsUsing eccentrically located perforators is simple method of extending real pedicle length, but there have been concerns regarding flap perfusion and distal vascularity. Our findings suggest that, in TDAP flaps, both eccentric and central perforator are safe options.