Three- and four-dimensional arterial and venous anatomies of the thoracodorsal artery perforator flap

Background: The vascular anatomy of the thoracodorsal artery perforator flap, which has not previously been elucidated, was examined using three- and four-dimensional computed tomographic angiography and venography. Methods: Twenty-five thoracodorsal artery perforator flaps were harvested from fresh cadavers from the Western population. Dynamic static computed tomographic angiography using iodinated contrast media was performed following cannulation of the largest perforator from the descending branch of the thoracodorsal artery and its vena comitans in 10 flaps. Imaging was repeated subsequent to flap thinning between the deep and superficial adipose layers. Colored latex injections and flap dissections were performed in a further 15 flaps to establish the location, caliber, and intramuscular length of the thoracodorsal artery perforators. Results: Two distinct perforator complex types were described. Flap thinning can be safely performed between the deep and superficial adipose layers without significantly affecting flap vascularity, provided that a safety zone about the perforator is respected. The superficial venous system consisted of large veins arranged in a polygonal pattern situated at the subdermal level and was connected to the deep system by the venae comitantes of the thoracodorsal artery perforators. Perforators from the descending branch of the thoracodorsal artery were found in reliable locations. Conclusions: Using a novel dynamic three-dimensional imaging technique, perfusion of the arterial and venous system of the thoracodorsal artery perforator flap was elucidated. Although the flap is inherently thin, it can be safely thinned between the superficial and deep adipose layers. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction.