Different types of suprafascial courses in thoracodorsal artery skin perforators

Background: The thoracodorsal artery perforator flap is a versatile flap for resurfacing soft-tissue defects. However, it is too bulky for resurfacing shallow defects. The authors used preoperative color Doppler sonography to identify the suprafascial courses of skin perforators to facilitate the design and thinning procedures of thoracodorsal artery perforator flaps. Methods: Thin thoracodorsal artery perforator flaps were designed in 29 patients. Preoperative color Doppler sonography was used to identify the penetrating points and suprafascial courses of skin perforators. According to the different orientations of suprafascial courses, skin perforators could be classified into three types. The designs and thinning procedures of flaps relied on the findings of preoperative color Doppler sonography. Results: Fifty-eight ideal perforators were marked on the 29 patients. Intraoperative dissections proved that 55 perforators were thoracodorsal artery skin perforators, and three perforators were intercostal artery perforators. In one patient, no skin perforator derived from the descending branch of the thoracodorsal artery was found during intraoperative dissection (3.4 percent). Suprafascial courses could be demonstrated by preoperative color Doppler sonography in 54 of the 55 thoracodorsal artery skin perforators. Nineteen were type 1 perforators (35.2 percent), 26 were type 2 perforators (48.1 percent), and nine were type 3 perforators (16.7 percent). Complications were encountered in six patients (20.7 percent), all of whom recovered well. Conclusions: The suprafascial courses of skin perforators facilitate the design and thinning procedures of thoracodorsal artery perforator flaps. They improve the survivability of flaps and make thinning procedures more secure and efficient.