1. Using Thoracodorsal Artery Perforator Flap with Intercostals Nerve in Reconstruction Surgery
使用帶神經的胸背動脈穿支皮瓣於重建手術
陳理維 林政達 劉文忠 徐圭璋 楊國強 何彥儀
高雄榮民總醫院 外科部 重建整形外科
Good morning, its of great honor to have the opportunity to give oral presentation with the topic of a dual role of the IKK/NF-kB pathway in this meeting. I got the grant from my hospital: Kaohsiung Veteran General Hospital and have been to Michael Karin’s lab in University in San Diego since June I have done some experiments there and have some results. Now, I am going to present those results.

2. Thoracodorsal Artery Perforator Flap
Arrow: deep fascial layer; L: Latissimus dorsi muscle, Sc septocutaneous ; Mc: muscuocutaneous; I, Intercostal artery perforator; Sa: serratus anterior muscle; R:rib; A: axial artery ; T; thoracodorsal artery

3. Thoracodorsal Artery Perforator Flap
Two types of skin perforators from the descending br.
Muscutaneous perforators: pierce LD muscle.
Septocutaneous perforators: not penetrate muscle, course laterally between LD and SA muscle.

4. Thoracodorsal Artery Perforator Flap with Vascularized Nerve Graft for Ulnar Nerve Reconstruction
Trauma induced a soft tissue with superficial branch of ulnar nerve defect over left hand.
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5. Sensate Free Flap
Add the sensory component of the free flap for the restoration of sensation.
It is useful in upper aerodigestive tract defects, phalloplasty, hand and foot reconstruction.
Radial forearm flap: most commonly used sensate flap: high donor site morbidity.
Lateral arm fasciocutaneous flap:
Ideal sensate free flaps: definite sensory nerve distribution, acceptable donor site morbidity, versatile flap.
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6. Sensate Thoracodorsal Artery Perforator Flap
The lateral cutaneous br of intercostal n bifurcates into an ant and post ramus. The posterior ramus courses along LD muscle and innervate skin over the muscle. D, deep fascia; I, intercostal n; T, thoracodorsal artery; P, thoracodorsal artery perforator; L, LD muscle ; S, SA muscle; Lc, lateral cutaneous br of interocostal n; Ar and Pr, anterior and posterior rami

7. Using Doppler to locate thoracodrosal a perforator and intercostal a perforator
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Concomitant intercostal a perforator
Conjoint type: 60%
Separate type
Conjoint type: a posterior ramus course above LD muscle and main trunk travel with TDAP and reach together.
Separate type: br of a posterior ramus enter the skin at different location from TDAP.

8. Sensate Thoracodorsal Artery Perforator Flap
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The recipient nerve was a branch of the sural nerve. Using intercostal artery perforator (Ia) to identify the course of the posterior ramus (I) of interocostal n. P, thoracodorsal artery perforator;

9. Sensate Thoracodorsal Artery Perforator Flap
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The flap was elevated and thinned without injury to the perforator and nerve. I, posterior ramus of interocostal n. P, thoracodorsal artery perforator;

10. Using Sensate TDAP Flap in Phalloplasty

12. Sensate Thoracodorsal Artery Perforator Flap
No difference existed in flap size between groups.
The test showed better tactile sensation at the center of the flap in the sensate group than in the nonsensated group at 6 and 12 mons (p < 0.01) postoperatively.
The tactile sensation at the peripheries of the flap between two gr: no significant difference at 6 months but significantly better in the sensate group than in nonsensated group at 12 months (p = 0.046).
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13. Conclusion
The sensate thoracodorsal artery perforator is an option for soft tissue reconstruction and restoration of sensibility with minimal donor site morbidity.
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