Rageh, T., Kishk, T., Ghozlan, A., El Nahas, M. (2025). Optimizing Axillary Reconstruction with Pedicled Thoracodorsal Artery Perforator Flaps: A Versatile Solution. The Egyptian Journal of Plastic and Reconstructive Surgery, 49(1), 65-75. doi: 10.21608/ejprs.2025.405224
Tarek Mohy Rageh; Tarek Fouad Kishk; Ayman Ghozlan; Mohamed Abdallah El Nahas. "Optimizing Axillary Reconstruction with Pedicled Thoracodorsal Artery Perforator Flaps: A Versatile Solution". The Egyptian Journal of Plastic and Reconstructive Surgery, 49, 1, 2025, 65-75. doi: 10.21608/ejprs.2025.405224
Rageh, T., Kishk, T., Ghozlan, A., El Nahas, M. (2025). 'Optimizing Axillary Reconstruction with Pedicled Thoracodorsal Artery Perforator Flaps: A Versatile Solution', The Egyptian Journal of Plastic and Reconstructive Surgery, 49(1), pp. 65-75. doi: 10.21608/ejprs.2025.405224
Rageh, T., Kishk, T., Ghozlan, A., El Nahas, M. Optimizing Axillary Reconstruction with Pedicled Thoracodorsal Artery Perforator Flaps: A Versatile Solution. The Egyptian Journal of Plastic and Reconstructive Surgery, 2025; 49(1): 65-75. doi: 10.21608/ejprs.2025.405224
Optimizing Axillary Reconstruction with Pedicled Thoracodorsal Artery Perforator Flaps: A Versatile Solution
1The Department of General & Oncological Surgery,,Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia
2Plastic Surgery Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia
Abstract
Background: The TDAPF offers a pedicled approach for AX reconstruction, characterized by consistent flap thickness, minimal donor site complications, and dependable vascular anatomy with a lengthy pedicle [1]. Objective: This study examines the merits, drawbacks, and possible complications associated with using the thoracodorsal artery perforator flap (TDAPF) for axillary (AX) reconstruction. Methods: This was a prospective cohort study performed at Menoufia University Hospital’s Surgery Department from January 2022 to January 2023, involving 20 patients needing AX reconstruction due to defects. Inclusion criteria included patients aged 18 to 60 years with AX contractures, suitable for anesthesia, and lacking significant underlying health issues. Results: Evaluation using the Constant-Murley score demonstrated a substantial enhancement in shoulder function after the procedure, approaching normal levels, particularly in terms of pain, daily activities, and range of motion. Preoperatively, abduction strength was largely unaffected, as the condition doesn’t directly impact shoulder muscles or the joint itself. The average preoperative Dermatology Life Quality Index (DLQI) score was 12.3 (range: 9–15), decreasing to 2.99 (range: 2–7) one year postoperative. Conclusion: AX reconstruction presents intricate challenges, necessitating careful selection of specific reconstructive techniques. TDAPFs have emerged as a significant option for AX reconstruction, either as standalone or combined with other methods.
Schmidt-Hansen M., Bromham N., Hasler E. and Reed M.W.: Axillary surgery in women with sentinel node-positive operable breast cancer: A systematic review with meta- analyses. Springer Plus, 5: p. 1-13, 2016. 2- Khan A.H., Ambedkar V. and Maurya R.K.: Comparing different modalities of managing postburn axillary contracture. Indian Journal of Burns, 28 (1): p. 63-68, 2020. 3- Karki D. and Ahuja R.B.: A review and critical appraisal of central axis flaps in axillary and elbow contractures. Burns & Trauma, 5, 2017. 4- Ching D.L., Mughal M., Papas A. and Soldin M.: Axillary reconstruction for hidradenitis suppurativa with an inner- arm transposition flap creating a brachioplasty effect. Archives of Plastic Surgery, 44 (03): p. 228-233, 2017. 5- Elan, Y., Xiongwei L. and Xiao L.: Diagnosis and treatment of axillary web syndrome: An overview. Chinese Journal of Plastic and Reconstructive Surgery, 2 (2): p. 128-136, 2020. 6- Cha J.A. and Yoon S.H.: Axillary Reconstruction Using a Pedicled Thoracodorsal Artery Perforator Flap Including Latissimus Dorsi Muscle Strip. Journal of Wound Management and Research, 16 (1): p. 43-48, 2020. 7- Kumaran S., Nambi G., Beck B., Paul M.K., Gupta A.K. and Dhanraj P.: A clinical study of post burn contracture of axilla & its management. Official publication of the National Academy of Burns-India, 2008. 8- Awad M.S.: Versatility of the Pedicled Thoracodorsal Artery Perforator Flap (TDAP) Anatomic Basis and Clinical Application in breast reconstruction. Zagazig University Medical Journal, 27 (2): p. 228-237, 2021. 9- Hawas E.M., Elboraey M.A., El Naggar A.N.M., Abdel Baset M.S., Ibrahim M.F. and Abdel Azeem K.M.: Reconstruction of the axilla by perforator-based propeller flap. The Egyptian Journal of Plastic and Reconstructive Surgery, 46 (2): p. 115-120, 2022. 10- Marchesi A., Marcelli S., Zingaretti N., Parodi P.C. and Vaienti L.: Pedicled thoracodorsal artery perforator and muscle-sparing latissimus dorsi flaps in the axillary reconstruction after hidradenitis suppurativa excision: Functional and aesthetic issues. Annals of plastic surgery, 81 (6): p. 694-701, 2018. 11- Ndiaye L., Sankale A., Ndiaye A., Foba M. and Coulibaly N.: Management of axillary burn contracture: A summary of 67 cases a Department of Plastic and Reconstructive Surgery. Aristide Le Dantec Hospital, Senegal Department of Orthopedic and Traumatology, Aristide Le Dantec Hospital, Senegal, 2018. Egypt, J. Plast. Reconstr. Surg., January 2025 75 12- Hantash S., Ayad W., Hendy A.A. and Sadaka M.S.: Clinical applications of the thoracodorsal artery perforator flap in extremity soft tissue reconstruction. The Egyptian Journal of Plastic and Reconstructive Surgery, 44 (2): p. 353- 359, 2020. 13- Elgohary H., Nawar A.M., Zidan A., Shoulah A.A., Younes M.T. and Hamed A.M.: Outcome of pedicled thoracodorsal artery perforator flap in the surgical treatment of stage II and III hidradenitis suppurativa of axilla. Annals of Plastic Surgery, 81 (6): p. 688-693, 2018. 14- Mohos B., Sándor G., Bognár G., Csucska M. and Lóderer Z.: Az arteria thoracodorsalis perforátor fasciocutan lebeny a krónikus axillaris hidradenitis suppurativa kezelésében. Magyar Sebészet (Hungarian Journal of Surgery), 70 (4): p. 303-306, 2017. 15- Hamdi M., Decorte T., Demuynck M., Defrene B., Fredrickx A., Van Maele G., et al.: Shoulder function after harvesting a thoracodorsal artery perforator flap. Plastic and Reconstructive Surgery, 122 (4): p. 1111-1117, 2008. 16- Mahfouz A.: Prascapular flap for reconstruction of sever axillary contracture. Plastic Surgery Unit, Surgery Department, Zagazig University Hospital, Zagazig, Egypt, 2013. 17- O’Brien, J., Wysocki J. and Anastasi G.: Limberg flap coverage for axillary defects resulting from excision of hidradenitis suppurativa. Plast. Reconstr. Surg., 58 (3): p. 354-8, 1976. 18- Chen S.L., Chen T. and Wang H.-J.: Free thoracodorsal artery perforator flap in extremity reconstruction: 12 cases. British Journal of Plastic Surgery, 57 (6): p. 525-530, 2004. 19- Kim K.N., Hong J.P., Park C.R. and Yoon C.S.: Modification of the elevation plane and defatting technique to create a thin thoracodorsal artery perforator flap. Journal of Reconstructive Microsurgery, 32 (02): p. 142-146, 2016. 20- Kulahci Y., Sever C., Uygur F., Oksuz S., Sahin C. and Duman H.: Pre-expanded pedicled thoracodorsal artery perforator flap for postburn axillary contracture reconstruction. Microsurgery, 31 (1): p. 26-31, 2011. 21- Sever C., Uygur F., Kulahci Y., Karagoz H. and Sahin C.: Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects. Indian Journal of Plastic Surgery, 45 (03): p. 478- 484, 2012.
View on SCiNiTO
Top