ContentHistoryandDevelopmentDefinitionandFeaturesAnatomyClinicalapplicationMeritsShortcomingsContentHistoryandDevelopment1History1989Koshimaperforatorflap2019AngrigianiTrunkPerforatorFlap(Firstreport).NamedlatissimusdorsiflapwithoutmuscleKim,Koshimacalleditthinninglatissimusdorsiflap2019Heitmannthoracodorsalarteryperforatatorflap(TDAP).FirstlynamedHistory1989Koshimaperforato2DefinitionThroughthelatissimusdorsithoracodorsalarteryperforator,onlycontainingskinandfasciasuperficialis`axialpatternskinflap.DefinitionThroughthelatissim3FeaturesCuttingflapindeepfascia;Reservelatissimusdorsi,nodamagenervithoracodorsalis;Directsutureofthedonorsitewithin7-10cm.FeaturesCuttingflapindeepf4AppliedanatomyTherewere3to6perforatorsoffthedistalmainthoracodorsaland/orit'slateralbranchwhichconstitutethevascularsupplyofthethoracodorsalarteryperforatorflap.Thefirstperforatorwaslocatedapproximately6~8cmbelowtheposterioraxillaryfold.Subsequentperforators,uptoatotalofthree,arisedat1.5~4cmintervalsinferiorlyoffthelateralbranch.Eachperforatordisplayeda3~5cmobliquecoursethroughthemuscletosupplytheoverlyingskin.Eachperforatingarterywas0.3~0.6mmindiameterandaccompaniedbytwovenaecomitans.AppliedanatomyTherewere3to5Fig.1A,Angiogramoftheintegumentofthechestandupperbackfromahumancadaverleadoxideandgelatininjectionspecimen.Theblacklineindicatesanoutlineofthelatissimusdorsi.B,Thedesignofthethoracodorsalarteryperforatorflap.Thereliablesizeofthethoracodorsalarteryperforatorflapthatcanbeelevatedonasingleperforator(TA-1)was15×8cm.Themaximumflapupto25cm×12cmwasharvestedontwoadjacentperforators(TA-1andTA-2).C,AngiogramofthelatissimusdorsimusclewiththethoracodorsalarteryFig.1A,Angiogramoftheinte6胸背動脈皮瓣(TDAP)課件7ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof8ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof9ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof10ClinicalapplicationPediclegraftingFreegraftingClinicalapplicationPediclegr11PediclegraftingRepairingthewoundsofhomonymybreast,neck,upperarm,shoulderandback,evenbreastreconstructionPediclegrafting12Freegrafting

ExtremitieswoundTrunkwoundHeadandneckdefectsFreegrafting

Extremitieswoun13Fig: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,2019,121(5):1632-1641.Fig:Acaseofsarcomaontheleft14KoshimaI,etal.Newthoracodorsalarteryperforator(TAPcp)flapwithcapillaryperforatorsforreconstructionofupperlimb.JPlastReconstrAesthetSurg,2019,63(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.KoshimaI,etal.Newthoracodor15MeritsBloodsupplyisreliable,andvascularpedicleislong.ItCanbeachievedfreetransplantationorwithapedicletransfertorepairthetrunkofthelimbs,butalsoforbreastreconstructionandrepairofmaxillofacialdefects.Thedonorsiteishiddenandcanbedirectlysutured.Thefunctionandthebeautyofthedonorareaaresmall.Flapthicknessuniformity,rarelyoccursecondaryoperationbloated.BasedonrepairneedcutthechimericorleafTDAPowingtodiversityofoperation.Kepttheintegrityoflatissimusdorsiandnervithoracodorsalis.Didnotaffactmovementfunctionofthelatissimusdorsi.Lesscomplicationofdonorsite.MeritsBloodsupplyisreliable16ShortcomingsSurgeryrisky:DifficultyPreoperativelocalization，Non-constantdiameterandposition，Demandmoremicrotechnique,ShortcomingsSurgeryrisky:17Prolongedoperationtime:

Changeposition

Donorandrecipientcan`tsimultaneouslyoperateProlongedoperationtime:18Others:myocutaneousarteryperforatorabsentormutatelimitedflapwidth7-10cmeffectingnormalbreastposition(female)Others:19胸背動脈皮瓣(TDAP)課件20胸背動脈皮瓣(TDAP)課件21ContentHistoryandDevelopmentDefinitionandFeaturesAnatomyClinicalapplicationMeritsShortcomingsContentHistoryandDevelopment22History1989Koshimaperforatorflap2019AngrigianiTrunkPerforatorFlap(Firstreport).NamedlatissimusdorsiflapwithoutmuscleKim,Koshimacalleditthinninglatissimusdorsiflap2019Heitmannthoracodorsalarteryperforatatorflap(TDAP).FirstlynamedHistory1989Koshimaperforato23DefinitionThroughthelatissimusdorsithoracodorsalarteryperforator,onlycontainingskinandfasciasuperficialis`axialpatternskinflap.DefinitionThroughthelatissim24FeaturesCuttingflapindeepfascia;Reservelatissimusdorsi,nodamagenervithoracodorsalis;Directsutureofthedonorsitewithin7-10cm.FeaturesCuttingflapindeepf25AppliedanatomyTherewere3to6perforatorsoffthedistalmainthoracodorsaland/orit'slateralbranchwhichconstitutethevascularsupplyofthethoracodorsalarteryperforatorflap.Thefirstperforatorwaslocatedapproximately6~8cmbelowtheposterioraxillaryfold.Subsequentperforators,uptoatotalofthree,arisedat1.5~4cmintervalsinferiorlyoffthelateralbranch.Eachperforatordisplayeda3~5cmobliquecoursethroughthemuscletosupplytheoverlyingskin.Eachperforatingarterywas0.3~0.6mmindiameterandaccompaniedbytwovenaecomitans.AppliedanatomyTherewere3to26Fig.1A,Angiogramoftheintegumentofthechestandupperbackfromahumancadaverleadoxideandgelatininjectionspecimen.Theblacklineindicatesanoutlineofthelatissimusdorsi.B,Thedesignofthethoracodorsalarteryperforatorflap.Thereliablesizeofthethoracodorsalarteryperforatorflapthatcanbeelevatedonasingleperforator(TA-1)was15×8cm.Themaximumflapupto25cm×12cmwasharvestedontwoadjacentperforators(TA-1andTA-2).C,AngiogramofthelatissimusdorsimusclewiththethoracodorsalarteryFig.1A,Angiogramoftheinte27胸背動脈皮瓣(TDAP)課件28ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof29ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof30ClinicalAnatomicAtlasofMicrosurgeryClinicalAnatomicAtlasof31ClinicalapplicationPediclegraftingFreegraftingClinicalapplicationPediclegr32PediclegraftingRepairingthewoundsofhomonymybreast,neck,upperarm,shoulderandback,evenbreastreconstructionPediclegrafting33Freegrafting

ExtremitieswoundTrunkwoundHeadandneckdefectsFreegrafting

Extremitieswoun34Fig: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,2019,121(5):1632-1641.Fig:Acaseofsarcomaontheleft35KoshimaI,etal.Newthoracodorsalarteryperforator(TAPcp)flapwithcapillaryperforatorsforreconstructionofupperlimb.JPlastReconstrAesthetSurg,2019,63(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.KoshimaI,etal.Newthoracodor36MeritsBloodsupplyisreliable,andvascularpedicleislong.It