Initial Temporary Vascular Insufficiency in Latissimus Dorsi and Thoracodorsal Perforator Flaps

BACKGROUND Initial temporary vascular insufficiency of the perforator flap is confused with real flap ischemia or congestion during the initial period of reconstruction. Latissimus dorsi and thoracodorsal perforator flaps are no exception. Since a reliable perforator is not always consistent in its location or diameter, and recipient vessels may not always be healthy, the vascular pedicle is frequently spastic or the flap is readily congested. Risk factors were reviewed and several preparations were necessary. METHODS In a preliminary study, 73 patients undergoing reconstruction with a latissimus dorsi or thoracodorsal perforator flap were retrospectively reviewed. Temporary flap congestion was observed in 10 patients (13.7 percent), and six risk factors were identified. To alleviate flap congestion, four supplementary measures were prepared for patients with risk factors: T-anastomosis for the flow dispersion, inclusion of an additional vein, inclusion of a supercharged perforator, and a muscle-sparing technique. RESULTS Flap congestion was observed in two of 32 patients (6.3 percent); there was no marginal necrosis. T-anastomosis was the most commonly prepared measure. An additional draining vein or a supercharged perforator was frequently used in large, thin, or relatively long flaps, and a muscle-sparing technique was used for flaps based on a less reliable perforator. CONCLUSIONS Perforator selection and careful dissection of the pedicle are required for successful reconstruction in latissimus dorsi or thoracodorsal perforator flaps. A perforator pedicle is more sensitive than a conventional flap, and flap congestion is a concern in patients with risk factors, even though most cases are relieved in time. To prevent congestion, the appropriate flap design with preparation of supplementary measures is recommended for better results when the flap is elevated.