胸背動(dòng)脈皮瓣(TDAP)課件

ThoracodorsalArteryPerforatatorFlapDepartmentofBurnandPlasticSurgery,AffiliatedHospitalofZunyiMedicalCollegeContentHistoryandDevelopmentDefinitionandFeaturesAnatomyClinicalapplicationMeritsShortcomingsHistory1989Koshimaperforatorflap1995AngrigianiTrunkPerforatorFlap(Firstreport).NamedlatissimusdorsiflapwithoutmuscleKim,Koshimacalleditthinninglatissimusdorsiflap2003Heitmannthoracodorsalarteryperforatatorflap(TDAP).FirstlynamedFeaturesCuttingflapindeepfascia;Reservelatissimusdorsi,nodamagenervithoracodorsalis;Directsutureofthedonorsitewithin7-10cm.AppliedanatomyTherewere3to6perforatorsoffthedistalmainthoracodorsaland/orit'slateralbranchwhichconstitutethevascularsupplyofthethoracodorsalarteryperforatorflap.Thefirstperforatorwaslocatedapproximately6~8cmbelowtheposterioraxillaryfold.Subsequentperforators,uptoatotalofthree,arisedat1.5~4cmintervalsinferiorlyoffthelateralbranch.Eachperforatordisplayeda3~5cmobliquecoursethroughthemuscletosupplytheoverlyingskin.Eachperforatingarterywas0.3~0.6mmindiameterandaccompaniedbytwovenaecomitans.Fig.1A,Angiogramoftheintegumentofthechestandupperbackfromahumancadaverleadoxideandgelatininjectionspecimen.Theblacklineindicatesanoutlineofthelatissimusdorsi.B,Thedesignofthethoracodorsalarteryperforatorflap.Thereliablesizeofthethoracodorsalarteryperforatorflapthatcanbeelevatedonasingleperforator(TA-1)was15×8cm.Themaximumflapupto25cm×12cmwasharvestedontwoadjacentperforators(TA-1andTA-2).C,AngiogramofthelatissimusdorsimusclewiththethoracodorsalarteryClinicalAnatomicAtlasofMicrosurgeryClinicalapplicationPediclegraftingFreegraftingFreegrafting

ExtremitieswoundTrunkwoundHeadandneckdefectsFig:Acaseofsarcomaontheleftshoulderofa56-year-oldman.(Above,left)Acompound(chimera)flapisdesigned.The

flapconsistsofathoracodorsalarteryperforatorflapwithasegmentoflatissimusdorsimuscletoreconstructthedeltoid

musclebecauseoftumorresection.(Above,right)Thelatissimusdorsisegment(10-5cm)wasdissectedwithavascularpedicleindependentofthepedicleofthethoracodorsalarteryperforatorflap(arrow).(Below,left)Themusclesegmentis

elevated.Theperforatorarisesfromthehorizontalbranchandcoursesunderthethoracodorsalnervebranch(twoarrows)toentertheskinpaddle(vesselloopandarrow).(Below,right)Thethoracodorsalarteryperforatorflapispassedunderthethoracodorsalnervethatisleftintacttotherestofthe

latissimusdorsimuscle.HamdiM,etal.SurgicalTechniqueinPedicledThoracodorsalArteryPerforatorFlaps:AClinicalExperiencewith99Patients.PlastReconstrSurg,2008,121(5):1632-1641.KoshimaI,etal.Newthoracodorsalarteryperforator(TAPcp)flapwithcapillaryperforatorsforreconstructionofupperlimb.JPlastReconstrAesthetSurg,2010,63(1):140-145.Fig:(A)A73-year-oldwomanwithwidelyinvadedskincanceronradiatedrighthand.Entiredorsalandpalmarskinwas

resected.(B)TAPflaponleftlateralthoracicregioninsupineposition.(C)ObtainedTAPflapwiththelateraldescendingbranch.(D)Schemaofreconstruction.Metacarpalboneofindex(M)wastransferredtocreateathumb.Thethoracodorsalartery(T)was

interposedintoradialarteryinaflow-throughfashion.(E)Oneyearaftersurgery.MeritsBloodsupplyisreliable,andvascularpedicleislong.ItCanbeachievedfreetransplantationorwithapedicletransfertorepairthetrunkofthelimbs,butalsoforbreastreconstructionandrepairofmaxillofacialdefects.Thedonorsiteishiddenandcanbedirectlysutured.Thefunctionandthebeautyofthedonorareaaresmall.Flapthicknessuniformity,rarelyoccursecondaryoperationbloated.BasedonrepairneedcutthechimericorleafTDAPowingtodiversityofoperation.Kepttheintegrityoflatissimusdorsiandnervithoracodorsalis.Didnotaffactmovementfunctionofthelatissimusdorsi.Lesscomplicationofdonorsite.ShortcomingsSurgeryrisky:Di