Perforator topography of the thoracodorsal artery perforator flap

Background: The anatomical topography of the perforators that pierce the latissimus dorsi muscle fascia determines the location and direction of the skin paddle and thus the ultimate design of the thoracodorsal artery perforator flap. The full scope of the thoracodorsal artery perforator topography has not been provided in detail, and the usefulness of perforators from the transverse branch has not been elucidated. Methods: While harvesting the thoracodorsal artery perforator flap, every reliable musculocutaneous perforator that derives from the thoracodorsal artery was documented. The number, location, and topographic patterns of the perforators were measured. Twenty-three patients (11 female and 12 male), with a mean age of 34.2 years, were enrolled in this prospective study. Results: A mean number of 4.3 reliable perforators was noted. Of 99 perforators that were documented in 23 latissimus dorsi muscles, 48 were situated along the course of the descending branches of the thoracodorsal artery and 30 were situated along the transverse branches. At least one perforator was found near the lateral muscle border in every muscle, but no reliable perforator was located adjacent to the medial muscle border in four cases. Pedicles of 23 thoracodorsal artery perforator flaps, 24 perforators from the descending branch, and six perforators from the transverse branch were dissected completely. The average intramuscular course of the perforators was 5.3 cm. Conclusions: The topographic results could be used as a reference in the perforator localization for safe and efficient harvesting of the thoracodorsal artery perforator flap.