Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series

BACKGROUND: Complex defects resulting in ablation of the scalp, the calvaria, the dura, and the underlying brain are still challenging. These defects require cranioplasty to restore the bone cosmetic and functional roles and free-flap soft tissue reconstruction to prevent cranioplasty exposure and further infection. Different materials have been used in cranioplasty, while different free flaps have been proposed in those cases. In this article, we present a case series of cranioplasty reconstruction with thoracodorsal artery perforator flap (TDAP).

PATIENTS AND METHODS: From April 2016 to January 2018, 5 patients underwent cranioplasty reconstruction using alloplastics and TDAP flap. Two patients underwent primary cranioplasty and 3 patients underwent secondary cranioplasty. The superficial temporal vessels were always dissected as recipient vessels.

RESULTS: The flap sizes range from 40 to 80 cm2 (mean 57 cm2 ) and the maximum pedicle length was 12 cm (mean 10 cm). All the donor sites were closed primary with minimal morbidity. No postoperative complications were experienced. All the flaps provided stable coverage with an acceptable color match. The mean follow-up time was 4 months.

CONCLUSIONS: Our data suggest that the TDAP may be employed in postcranioplasty reconstruction. The TDAP has more advantages compared to other flaps used in alloplastic reconstruction: a broad large surface, a long pedicle, and a thinner thickness.