Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction
Summary:. The thoracodorsal artery perforator (TDAP) flap has a long vascular pedicle that is ideal for lower extremity reconstruction, but it generally relies on the presence of a dominant septocutaneous perforator vessel. Surgical delay optimizes flap survival by creating relative ischemia to augm...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-03-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004880 |
| _version_ | 1797859631711649792 |
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| author | Mallorie L. Huff, BS Ahmed M. Mansour, MD Mamtha S. Raj, MD Robert J. Allen, Sr, MD Sean J. Wallace, MD, MS |
| author_facet | Mallorie L. Huff, BS Ahmed M. Mansour, MD Mamtha S. Raj, MD Robert J. Allen, Sr, MD Sean J. Wallace, MD, MS |
| author_sort | Mallorie L. Huff, BS |
| collection | DOAJ |
| description | Summary:. The thoracodorsal artery perforator (TDAP) flap has a long vascular pedicle that is ideal for lower extremity reconstruction, but it generally relies on the presence of a dominant septocutaneous perforator vessel. Surgical delay optimizes flap survival by creating relative ischemia to augment perforator vessels. In this report, we describe the use of a delayed free TDAP flap in the setting of an absent dominant perforator vessel for the reconstruction of a calcaneal degloving injury. A 22-year-old actively smoking patient with a body mass index of 33.5 presented with a nonhealing left heel wound with overlying necrotic changes after traumatic degloving injury. The entire weight-bearing portion of the calcaneal fat pad and the flanking regions were debrided. The TDAP flap was elevated, revealing three small thoracodorsal artery perforators. Given that a dominant perforator was absent, the flap was surgically delayed. Free-tissue transfer occurred 8 days later. This operation was conducted entirely in left lateral decubitus with simultaneous wound preparation and flap harvest. The flap was elevated on two perforators to elongate the pedicle’s length and inset to cover exposed calcaneus and pad the heel. Six months postoperatively, the patient is doing well without flap compromise or ulceration. The TDAP flap is a versatile microsurgical tool, and surgical delay extends the utility of this flap when a dominant septocutaneous perforator is unavailable. Recipient site debridement may occur simultaneously with the TDAP delay procedure. Importantly, only one position is required for flap elevation, microsurgical anastomosis, and insetting, thus obviating intraoperative repositioning. |
| first_indexed | 2024-04-09T21:32:42Z |
| format | Article |
| id | doaj.art-8fc31484170a4389814a93c49b3e697a |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-09T21:32:42Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-8fc31484170a4389814a93c49b3e697a2023-03-27T06:47:44ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742023-03-01113e488010.1097/GOX.0000000000004880202303000-00049Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury ReconstructionMallorie L. Huff, BS0Ahmed M. Mansour, MD1Mamtha S. Raj, MD2Robert J. Allen, Sr, MD3Sean J. Wallace, MD, MS4From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, Pa.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, Pa.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, Pa.† Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La.From the * Department of Surgery, Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network/USF Morsani College of Medicine, Allentown, Pa.Summary:. The thoracodorsal artery perforator (TDAP) flap has a long vascular pedicle that is ideal for lower extremity reconstruction, but it generally relies on the presence of a dominant septocutaneous perforator vessel. Surgical delay optimizes flap survival by creating relative ischemia to augment perforator vessels. In this report, we describe the use of a delayed free TDAP flap in the setting of an absent dominant perforator vessel for the reconstruction of a calcaneal degloving injury. A 22-year-old actively smoking patient with a body mass index of 33.5 presented with a nonhealing left heel wound with overlying necrotic changes after traumatic degloving injury. The entire weight-bearing portion of the calcaneal fat pad and the flanking regions were debrided. The TDAP flap was elevated, revealing three small thoracodorsal artery perforators. Given that a dominant perforator was absent, the flap was surgically delayed. Free-tissue transfer occurred 8 days later. This operation was conducted entirely in left lateral decubitus with simultaneous wound preparation and flap harvest. The flap was elevated on two perforators to elongate the pedicle’s length and inset to cover exposed calcaneus and pad the heel. Six months postoperatively, the patient is doing well without flap compromise or ulceration. The TDAP flap is a versatile microsurgical tool, and surgical delay extends the utility of this flap when a dominant septocutaneous perforator is unavailable. Recipient site debridement may occur simultaneously with the TDAP delay procedure. Importantly, only one position is required for flap elevation, microsurgical anastomosis, and insetting, thus obviating intraoperative repositioning.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004880 |
| spellingShingle | Mallorie L. Huff, BS Ahmed M. Mansour, MD Mamtha S. Raj, MD Robert J. Allen, Sr, MD Sean J. Wallace, MD, MS Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction |
| title_full | Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction |
| title_fullStr | Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction |
| title_full_unstemmed | Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction |
| title_short | Delayed Thoracodorsal Artery Perforator Free Flap for Calcaneal Degloving Injury Reconstruction |
| title_sort | delayed thoracodorsal artery perforator free flap for calcaneal degloving injury reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004880 |
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