Use of Thoracodorsal Artery Perforator (Tdap) Flap to Cover a Laparoscopically Harvested Omental Flap After Modified Rad
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CASE REPORT
Use of Thoracodorsal Artery Perforator (Tdap) Flap to Cover a Laparoscopically Harvested Omental Flap After Modified Radical Mastectomy; a Case Report Ashraf Khater 1 & Khaled Abdelwahab 1 & Amr Hossam El din Sedky 1 & Khaled Gaballa 1 Received: 1 March 2019 / Accepted: 8 January 2020 # Indian Association of Surgical Oncology 2020
Abstract Omental flap was introduced for breast reconstruction after mastectomy either alone or as an adjunct to prosthetic reconstruction. Laparoscopically harvested omental flap was used successfully for this issue. Most of reports had described its use after partial mastectomy, skin or nipple areola sparing mastectomies. In this case, we used the thoracodorsal artery perforator (Tdap) flap as a cover for the omental flap in a patient who underwent modified radical mastectomy. Modified radical mastectomy was done in the usual fashion. The descending branch of the thoracodorsal vessel was traced till its main perforator in an antegrade fashion. Then, the supplied skin island flap was created and rotated to cover the laparoscopically harvested omental flap that was delivered after its mobilization through a small epigastric wound from underneath the inner aspect of the lower mastectomy flap. The overall operative time was around 150 min. No blood transfusion was required. Pain score was around 6–7 in the early postoperative hours. No major complications were encountered, and the patient was discharged at the third postoperative day. The overall esthetic score was expressed as “good.” To our knowledge, this is the first time to report usage of laparoscopically harvested omental flap after modified radical mastectomy with skin coverage by the thoracodorsal artery perforator (Tdap) flap. One criticism that may arise is the dual flap reconstruction; however, this method still as an alternative to the myocutaneous flaps with a reasonable operative time and minimal donor site and overall morbidities with good esthetic outcome. Modified radical mastectomy can be safely and efficiently reconstructed using a laparoscopically harvested omental flap with a cutaneous coverage using the thoracodorsal artery perforator (Tdap) flap. Keywords Omental flap . Thoracodorsal artery perforator (Tdap) flap . Laparoscopy-mastectomy
Background Omental flap was described a long time ago by Kiricuta for breast reconstruction after mastectomy [1]. Advantages of omentum are numerous [2, 3] especially its vascular reliability, peculiar adaptability that makes it fit for any cavity, peculiar volume increase which is due to its absorptive phenomena, and its immune function [3]. Early trials used the pedicled omental flap in breast reconstruction through a laparotomy incision [2, 4]. Saltz reported a laparoscopically harvested omental flap to cover a large soft tissue defect in 1993 [5]. This opened the gate for a
multiple series about the use of laparoscopically harvested omental free flap after either skin sparing mastectomy [6–10] or partial mastectomy [11]. The main drawback of this flap is that its
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