Expanding Flap Territory With Intraflap Anastomosis in Thoracodorsal Artery Perforator and Anterolateral Thigh Flaps: Feasibility and Strategic Considerations.

PURPOSE: When reconstructing extensive defects with large perforator flaps, incorporating multiple perforators from different perforasomes may improve perfusion reliability, for which intraflap anastomosis can be an effective strategy. Although well described in breast reconstruction, its application in other perforator flaps remains limited. This report reviews its application in thoracodorsal artery perforator (TDAP) and anterolateral thigh (ALT) flaps to explore feasible strategies.

METHODS

Patients who underwent reconstruction with bipedicled ALT or TDAP flaps using intraflap anastomosis between 2019 and 2023 were reviewed. This technique was reserved for cases requiring large flaps without a single dominant perforator, necessitating multiple perforators from different source vessels. Operative details and postoperative outcomes were evaluated.

RESULTS

Twelve cases (six TDAP and six ALT flaps) were analyzed. Median defect and flap sizes were 224 and 238.5 cm2, respectively. In the TDAP group, the descending branch of the thoracodorsal artery was most commonly used as the primary pedicle, and its serratus branch served as the recipient for intraflap anastomosis with the dorsal intercostal or scapular artery perforator. In the ALT group, the descending branch of the lateral circumflex femoral artery was the primary pedicle, with the oblique or ascending branch as the secondary; the distal runoff of the descending branch served as the recipient. Except for one case of tip necrosis, no perfusion-related complications occurred.

CONCLUSION

This small retrospective report suggests that the intraflap anastomosis technique appears to be a feasible approach for expanding vascular territories in TDAP and ALT flaps, offering a valuable option for extensive defect reconstruction when indicated.