胸背动脉皮瓣TDAP培训课件.ppt

1、本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Content History and Development Definition and Features Anatomy Clinical application Merits Shortcomings本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。History 1989 Koshima perforator flap 1995 Angrigiani Trunk Perforator Flap(First report).Named latis

2、simus dorsi flap without muscle Kim,Koshima called it thinning latissimus dorsi flap 2003 Heitmann thoracodorsal artery perforatator flap(TDAP).Firstly named本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Definition Through the latissimus dorsi thoracodorsal artery perforator,only containing skin an

3、d fascia superficialis axial pattern skin flap.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Features Cutting flap in deep fascia;Reserve latissimus dorsi,no damage nervi thoracodorsalis;Direct suture of the donor site within 7-10cm.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Applied anatomy T

4、here were 3 to 6 perforators off the distal main thoracodorsal and/or its lateral branch which constitute the vascular supply of the thoracodorsal artery perforator flap.The first perforator was located approximately 68 cm below the posterior axillary fold.Subsequent perforators,up to a total of thr

5、ee,arised at 1.54 cm intervals inferiorly off the lateral branch.Each perforator displayed a 35 cm oblique course through the muscle to supply the overlying skin.Each perforating artery was 0.30.6 mm in diameter and accompanied by two venae comitans.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Fi

6、g.1 A,Angiogram of the integument of the chest and upper back from a human cadaver lead oxide and gelatin injection specimen.The black line indicates an outline of the latissimus dorsi.B,The design of the thoracodorsal artery perforator flap.The reliable size of the thoracodorsal artery perforator f

7、lap that can be elevated on a single perforator(TA-1)was 15 8 cm.The maximum flap up to 25 cm 12 cm was harvested on twoadjacent perforators(TA-1 and TA-2).C,Angiogram of the latissimus dorsi muscle with the thoracodorsal artery本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。本文档所提供的信息仅供参考之用，不能作为科学依据

8、，请勿模仿；如有不当之处，请联系网站或本人删除。Clinical Anatomic Atlas of Microsurgery本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Clinical Anatomic Atlas of Microsurgery本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Clinical Anatomic Atlas of Microsurgery本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Clinical applic

9、ation Pedicle grafting Free grafting本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Pedicle grafting Repairing the wounds of homonymy breast,neck,upper arm,shoulder and back,even breast reconstruction本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Free grafting Extremities wound Trunk wound Head and

10、 neck defects本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Fig:Acase of sarcomaonthe left shoulder of a 56-year-old man.(Above,left)Acompound(chimera)flap is designed.The flap consists of a thoracodorsal artery perforator flap with a segment of latissimus dorsi muscle to reconstruct the deltoid mu

11、scle because of tumor resection.(Above,right)The latissimus dorsi segment(10-5 cm)was dissected with a vascularpedicle independent of the pedicle of the thoracodorsal artery perforator flap(arrow).(Below,left)The muscle segment is elevated.The perforator arises from the horizontal branch and courses

12、 under the thoracodorsal nerve branch(two arrows)to enter the skin paddle(vessel loop and arrow).(Below,right)The thoracodorsal artery perforator flap is passed under thethoracodorsal nerve that is left intact to the rest of the latissimus dorsi muscle.Hamdi M,et al.Surgical Technique in Pedicled Th

13、oracodorsal Artery Perforator Flaps:A Clinical Experience with 99 Patients.Plast Reconstr Surg,2008,121(5):1632-1641.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Koshima I,et al.New thoracodorsal artery perforator(TAPcp)flap with capillary perforators for reconstruction of upper limb.J Plast Reco

14、nstr Aesthet Surg,2010,63(1):140-145.Fig:(A)A 73-year-old woman with widely invaded skin cancer on radiated right hand.Entire dorsal and palmar skin was resected.(B)TAP flap on left lateral thoracic region in supine position.(C)Obtained TAP flap with the lateral descending branch.(D)Schema of recons

15、truction.Metacarpal bone of index(M)was transferred to create a thumb.The thoracodorsal artery(T)was interposed into radial artery in a flow-through fashion.(E)One year after surgery.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Merits Blood supply is reliable,and vascular pedicle is long.It Can b

16、e achieved free transplantation or with a pedicle transfer to repair the trunk of the limbs,but also for breast reconstruction and repair of maxillofacial defects.The donor site is hidden and can be directly sutured.The function and the beauty of the donor area are small.Flap thickness uniformity,ra

17、rely occur secondary operation bloated.Based on repair need cut the chimeric or leaf TDAP owing to diversity of operation.Kept the integrity of latissimus dorsi and nervi thoracodorsalis.Did not affact movement function of the latissimus dorsi.Less complication of donor site.本文档所提供的信息仅供参考之用，不能作为科学依据

18、，请勿模仿；如有不当之处，请联系网站或本人删除。Shortcomings Surgery risky:Difficulty Preoperative localization，Non-constant diameter and position，Demand more microtechnique,本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Prolonged operation time:Change position Donor and recipient cant simultaneously operate本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Others:myocutaneous artery perforator absent or mutate limited flap width 7-10cm effecting normal breast position(female)