Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair

Huang Guangtao; Wei Zairong; Huang Li; Li Shujun; Chen Wei; Yang Chenglan; Nie Kaiyu; Deng Chengliang; Wang Dali

doi:10.3760/cma.j.cn501120-20201207-00519

Volume 38 Issue 2

Feb. 2022

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(2): 165-169

Huang GT,Wei ZR,Huang L,et al.Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair[J].Chin J Burns Wounds,2022,38(2):165-169.DOI: 10.3760/cma.j.cn501120-20201207-00519.

Citation:

PDF( 4010 KB)

Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair

doi: 10.3760/cma.j.cn501120-20201207-00519

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China

Funds:

Science and Technology Project of Guizhou Province of China 2020-5012, 2019-4441

Collaborative Innovation Center of Chinese Ministry of Education and Guizhou Province 2020-39

More Information

Corresponding author: Wei Zairong, Email: 188116999@qq.com
Received Date: 2020-12-07

Abstract

Abstract

Objective To explore the clinical application value of two longitudes three transverses method in the location of the perforator of thoracodorsal artery perforator and deep wound repair. Methods The retrospectively observational study was conducted. From December 2018 to June 2020, 17 patients with deep wounds who were admitted to the Affiliated Hospital of Zunyi Medical University met the inclusion criteria and were included in this study, including 7 males and 10 females, aged 12 to 72 years. The wound areas of patients after debridement were 7 cm×3 cm to 11 cm×7 cm. Two longitudinal lines were located through the midpoint of the armpit, the posterior superior iliac spine, and the protruding point of the sacroiliac joint, and three transverse lines were located 5, 10, and 15 cm below the midpoint of the armpit between the two longitudinal lines, i.e. two longitudes three transverses method, resulting in two trapezoidal areas. And then the thoracodorsal artery perforators in two trapezoidal areas were explored by the portable Doppler blood flow detector. On this account, a single or lobulated free thoracodorsal artery perforator flap or flap that carrying partial latissimus dorsi muscle, with an area of 7 cm×4 cm to 12 cm×8 cm was designed and harvested to repair the wound. The donor sites were all closed by suturing directly. The number and location of thoracodorsal artery perforators, and the distance from the position where the first perforator (the perforator closest to the axillary apex) exits the muscle to the lateral border of the latissimus dorsi in preoperative localization and intraoperative exploration, the diameter of thoracodorsal artery perforator measured during operation, and the flap types were recorded. The survivals of flaps and appearances of donor sites were followed up. Results The number and location of thoracodorsal artery perforators located before operation in each patient were consistent with the results of intraoperative exploration. A total of 42 perforators were found in two trapezoidal areas, with 2 or 3 perforators each patient. The perforators were all located in two trapezoid areas, and a stable perforator (the first perforator) was located and detected in the first trapezoidal area. There were averagely 1.47 perforators in the second trapezoidal area. The position where the first perforator exits the muscle was 2.1-3.1 cm away from the lateral border of the latissimus dorsi. The diameters of thoracodorsal artery perforators were 0.4-0.6 mm. In this group, 12 cases were repaired with single thoracodorsal artery perforator flap, 3 cases with lobulated thoracodorsal artery perforator flap, and 2 cases with thoracodorsal artery perforator flap carrying partial latissimus dorsi muscle. The patients were followed up for 6 to 16 months. All the 17 flaps survived with good elasticity, blood circulation, and soft texture. Only linear scar was left in the donor area. Conclusions The two longitudes three transverses method is helpful to locate the perforator of thoracodorsal artery perforator flap. The method is simple and reliable. The thoracodorsal artery perforator flap designed and harvested based on this method has good clinical effects in repairing deep wound, with minimal donor site damage.
- Wounds and injuries,
- Surgical flaps,
- Thoracodorsal artery perforator flap,
- Two longitudes three transverses method,
- Latissimus dorsi muscle

FullText(HTML)

References(30)

References

[1]	杜威,唐举玉.胸背动脉穿支皮瓣的研究进展[J].中国临床解剖学杂志,2013,31(3):365-367.DOI: 10.13418/j.issn.1001-165x.2013.03.021.
[2]	TobinGR,SchustermanM,PetersonGH,et al.The intramuscular neurovascular anatomy of the latissimus dorsi muscle: the basis for splitting the flap[J].Plast Reconstr Surg,1981,67(5):637-641.DOI: 10.1097/00006534-198105000-00011.
[3]	AngrigianiC,GrilliD,SiebertJ.Latissimus dorsi musculocutaneous flap without muscle[J].Plast Reconstr Surg,1995,96(7):1608-1614.DOI: 10.1097/00006534-199512000-00014.
[4]	肖海涛,王怀胜,刘勇,等.胸背动脉穿支皮瓣修复烧伤后严重手背瘢痕挛缩畸形[J].中国修复重建外科杂志,2019,33(6):717-720.DOI: 10.7507/1002-1892.201809091.
[5]	胡长青,连勇,白晓亮,等.游离胸背动脉穿支皮瓣修复小腿远端及足踝部创面九例[J].中华烧伤杂志,2018,34(4):240-242.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.009.
[6]	周丹亚,潘佳栋,胡瑞斌,等.游离胸背动脉穿支皮瓣在四肢创面修复中的临床应用[J].中华显微外科杂志,2018,41(3):243-246.DOI: 10.3760/cma.j.issn.1001-2036.2018.03.010.
[7]	徐广琪,李志宇,霍然,等.躯干部穿支皮瓣在胸部创面修复中的应用[J].中华整形外科杂志,2020,36(9):1024-1028.DOI: 10.3760/cma.j.cn114453-20200116-00014.
[8]	龙海光,叶华,邹崇琪,等.游离胸背动脉穿支皮瓣修复头皮肿瘤创面15例[J].中华显微外科杂志,2016,39(6):606-608.DOI: 10.3760/cma.j.issn.1001-2036.2016.06.029.
[9]	KimEJ,LeeKT,LimSY,et al.Reconstructing facial contour deformities using stereoscopic thoracodorsal artery perforator adipofascial flaps[J].Microsurgery,2017,37(4):300-306.DOI: 10.1002/micr.22462.
[10]	刘晓韬,张干林,王爱武,等.胸背动脉穿支扩张皮瓣游离移植修复面颈部大面积瘢痕[J].中华整形外科杂志,2015,31(2):134-136.DOI: 10.3760/cma.j.issn.1009-4598.2015.02.014.
[11]	胡瑞斌,周丹亚,王欣,等.游离胸背动脉穿支皮瓣整复面部亚单位大面积瘢痕的临床效果[J].中华烧伤杂志,2020,36(7):586-589.DOI: 10.3760/cma.j.cn501120-20190505-00223.
[12]	汪星,何英剑,李金锋,等.胸背动脉穿支组织瓣用于乳腺癌保留乳房手术联合一期部分乳房成形术33例临床分析[J].中华外科杂志,2017,55(2):120-125.DOI: 10.3760/cma.j.issn.0529-5815.2017.02.009.
[13]	LorenzenMM,GunnarssonGL,BilleC,et al.Visualized bilateral breast reconstruction by propeller thoracodorsal artery perforator flaps[J].Gland Surg,2019,8(Suppl 4):S262-270.DOI: 10.21037/gs.2019.04.05.
[14]	宋达疆,李赞,章一新,等.联体双侧血管蒂腹壁下动脉穿支皮瓣行乳房重建[J].中华显微外科杂志,2020,43(5):441-445.DOI: 10.3760/cma.j.cn441206-20200225-00097.
[15]	许扬滨,向剑平,刘小林,等.不带背阔肌的胸背动脉穿支皮瓣的设计和应用[J].中华显微外科杂志,2006,29(5):335-337,插图5-2.DOI: 10.3760/cma.j.issn.1001-2036.2006.05.006.
[16]	常树森,魏在荣,金文虎,等.股前外侧皮瓣三纵五横法设计方案的临床研究[J].中华整形外科杂志,2019,35(6):571-576. DOI: 10.3760/cma.j.issn.1009-4598.2019.06.011.
[17]	HeitmannC,GuerraA,MetzingerSW,et al.The thoracodorsal artery perforator flap: anatomic basis and clinical application[J].Ann Plast Surg,2003,51(1):23-29.DOI: 10.1097/01.SAP.0000054189.14799.F3.
[18]	唐举玉,杜威,宋达疆,等.胸背动脉穿支皮瓣移植修复不同部位皮肤软组织缺损16例[J].中华整形外科杂志,2013,29(3):178-180.DOI: 10.3760/cma.j.issn.1009-4598.2013.03.006.
[19]	ChenSL,ChenTM,WangHJ.Free thoracodorsal artery perforator flap in extremity reconstruction: 12 cases[J].Br J Plast Surg,2004,57(6):525-530.DOI: 10.1016/j.bjps.2004.04.018.
[20]	YangLC,WangXC,BentzML,et al.Clinical application of the thoracodorsal artery perforator flaps[J].J Plast Reconstr Aesthet Surg,2013,66(2):193-200.DOI: 10.1016/j.bjps.2012.09.005.
[21]	LinCT,HuangJS,YangKC,et al.Reliability of anatomical landmarks for skin perforators of the thoracodorsal artery perforator flap[J].Plast Reconstr Surg,2006,118(6):1376-1386.DOI: 10.1097/01.prs.0000239525.44657.81.
[22]	KimYH,KimKH,SungKY,et al.Toe resurfacing with a thin thoracodorsal artery perforator flap[J].Microsurgery,2017,37(4):312-318.DOI: 10.1002/micr.30007.
[23]	刘安铭,欧昌良,周鑫,等.胸背动脉穿支皮瓣在修复手背软组织缺损中的临床应用[J].中华显微外科杂志,2020,43(2):176-178.DOI: 10.3760/cma.j.cn441206-20190609-00200.
[24]	庄加川,张振伟,李敏姣,等.胸背动脉穿支皮瓣修复手部皮肤缺损的临床应用[J].中华手外科杂志,2018,34(3):161-163.DOI: 10.3760/cma.j.issn.1005-054X.2018.03.001.
[25]	王先成,熊祥,方柏荣,等.胸背动脉穿支皮瓣修复乳房缺损畸形的临床应用[J].组织工程与重建外科杂志,2015,11(2):69-71.DOI: 10.3969/j.issn.1673-0364.2015.02.004.
[26]	蔡国荣,郭翱,张文亚,等.游离胸背动脉穿支皮瓣修复足踝部皮肤软组织缺损12例[J].中华显微外科杂志,2016,39(4):399-402.DOI: 10.3760/cma.j.issn.1001-2036.2016.04.028.
[27]	王晓峰,李学渊,丁文全,等.胸背动脉穿支皮瓣的显微解剖及临床应用[J].中华显微外科杂志,2020,43(5):481-485.DOI: 10.3760/cma.j.cn441206-20200528-00244.
[28]	AngrigianiC,RancatiA,EscuderoE,et al.Propeller thoracodorsal artery perforator flap for breast reconstruction[J].Gland Surg,2014,3(3):174-180.DOI: 10.3978/j.issn.2227-684X.2014.06.04.
[29]	杨大平,唐茂林,GeddesCR.胸背动脉穿支皮瓣的解剖研究和临床应用[J].中国临床解剖学杂志,2006,24(3):240-242.DOI: 10.3969/j.issn.1001-165X.2006.03.005.
[30]	DastS,HavetE,DessenaL,et al.Anatomical basis of the extended TDAP flap: study of its territories of vascularization and its volume[J].Surg Radiol Anat,2017,39(8):821-826.DOI: 10.1007/s00276-016-1811-x.

Relative Articles

[1]	Zhao Shuming, Liu Na, Liu Xueliang, Ji Shaolin. Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(3): 281-288. doi: 10.3760/cma.j.cn501225-20231012-00111
[2]	Zhang Tao, Liu Zhijin, Liu Shengzhe, Cheng Junnan, Yang Lin, Zhou Rong, Guo Liping, Yang Liang, Xiong Sheng, Ju Jihui. Clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(8): 753-758. doi: 10.3760/cma.j.cn501120-20210604-00211
[3]	Qi Jianwu, Chen Shao, Sun Binhong, Chai Yitong, Huang Jian, Li Yi, Yang Keyue, Sun Heyang, Chen Hong. Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(4): 347-353. doi: 10.3760/cma.j.cn501120-20210421-00145
[4]	Ma Fuxin, Ren Pan, Cao Jin, Bian Yongqian, Zhou Jiahua, Zhao Congying. Clinical application of three-dimensional printed preformed titanium mesh combined with free latissimus dorsi muscle flap in the treatment of squamous cell carcinoma with skull defect in the vertex[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(4): 341-346. doi: 10.3760/cma.j.cn501120-20201221-00538
[5]	Song Dajiang, Li Zan, Zhou Xiao, Zhang Yixin, Peng Xiaowei, Feng Guang, Zhou Bo, Lyu Chunliu, Wu Peng, Tang Yuanyuan, Peng Wen, Mao Huangxing, Liu Zeyang, Han Weiqing, Chen Yile, Tang Dihong, Zhou Yanjie, Zhang Keqiang. Selection and effects of flap/myocutaneous flap repair methods for the defect after perineum tumor resection[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(6): 451-457. doi: 10.3760/cma.j.cn501120-20190320-00129
[6]	Ma Chao, Tao Ran, Shu Jun, Lei Yonghong, Han Yan. Methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and management of secondary wound in donor site[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(12): 1199-1203. doi: 10.3760/cma.j.cn501120-20191121-00439
[7]	Hu Ruibin, Zhou Danya, Wang Xin, Zhu Liang, Zhang Yixin, Xu Heng. Clinical effect of free thoracodorsal artery perforator flap in reconstructing large scar on the facial subunit[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(7): 586-589. doi: 10.3760/cma.j.cn501120-20190505-00223
[8]	Jiang Conghang, Wang Xiancheng, Li Xiaofang, Xiong Xiang, Sun Yang, Meng Xianxi. Effect of pedicled thoracodorsal artery perforator flap on the repair of moderate to severe axillary scar contracture deformity[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(6): 480-483. doi: 10.3760/cma.j.cn501120-20190322-00133
[9]	Li Pandeng, Shen Guoliang. Clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar defect of ankle[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(5): 392-394. doi: 10.3760/cma.j.issn.1009-2587.2019.05.013
[10]	Gao Qiufang, Zhang Xiaofeng, Zhang Wanfeng, Ma Bin, Niu Xuetao, Ma Yajun, Li Zibiao, Liu Ning. Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2019, 35(1): 65-68. doi: 10.3760/cma.j.issn.1009-2587.2019.01.012
[12]	Tao Xianyao, Zhou Zongwei, Yang Lianghui, Gao Weiyang, Wang Long, Ding Jian, Feng Xiaoliang. Effects of pretreatment with dimethyloxalylglycine on the survival of multi-territory perforator flap in rat and related mechanism[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(7): 396-401. doi: 10.3760/cma.j.issn.1009-2587.2016.07.003
[14]	Zhang Minghua, Cui Xu, Zeng Jizhang, Liu Xiong, Huang Mitao, Zhang Pihong, Huang Xiaoyuan. Repair of large and deep skin and soft tissue defects around the knee joints with free latissimus dorsi musculocutaneous flaps[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2015, 31(5): 337-339. doi: 10.3760/cma.j.issn.1009-2587.2015.05.005
[16]	Li Junjie, Gao Zimian, Gao Weiyang, Li Zhefeng. Effects of surgical delay procedure on the survival of perforator flap with three angiosomes in rat and its mechanism[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(4): 337-343. doi: 10.3760/cma.j.issn.1009-2587.2014.04.013
[17]	ZHANG Pi-hong, HUANG Xiao-yuan, LONG Jian-hong, FAN Peng-ju, REN Li-eheng, ZENG Ji-zhang, XIAO Mu-zhang. Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2009, 25(1): 18-21. doi: 10.3760/cma.j.issn.1009-2587.2009.01.008

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(2)

Get Citation

PDF

XML

Article Metrics

Article views (381) PDF downloads(48)

Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair

doi: 10.3760/cma.j.cn501120-20201207-00519

Abstract

References

Relative Articles

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Clinical application effects of two longitudes three transverses method in perforator location of thoracodorsal artery perforator flap and deep wound repair

doi: 10.3760/cma.j.cn501120-20201207-00519

Abstract

References

Relative Articles

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Export File

Citation

Format

Content