Transverse Sensate Thoracodorsal Artery Perforator Flap for Finger Reconstruction

In the chapter, authors demonstrate three clinical cases using transverse sensate thoracodorsal artery perforator flaps to reconstruct soft tissue defects of fingers. The three cases consist of dorsal, palmar, and circumferential soft tissue defects of the fingers and thumb. Treatment plan and reconstructive options are discussed. For surgical planning, authors show steps of operating preoperative color Doppler sonography to identify and locate thoracodorsal artery perforators and intercostal arteries. The location of intercostal artery helps to mark the approximate course of intercostal nerve because of their concomitant relation. The conjoint and separate relations between thoracodorsal artery perforator and intercostal nerve are described, which influence subsequent flap thinning. Transverse or oblique orientation of flap design is advocated for better coverage of perforasome and dermatome and more acceptable donor site scar. The flap harvest and technical pearls are presented. Preoperative preparation and postoperative management of the cases are shown, including the tools for assessment of sensory recovery. Avoiding and managing problems are discussed, and certain patients not suitable for reconstruction by using the flap are listed. In conclusion, the transverse sensate thoracodorsal artery perforator flap is an option of soft tissue reconstruction when sensory recovery is critical.