Short pedicle thoracodorsal artery perforator (TAP) adiposal flap for three-dimensional reconstruction of contracted orbital cavity.

Abstract

Eye socket reconstruction for orbital contracture after removal of retinoblastoma remains challenging, because it is often accompanied by atrophy of facial soft tissue, malar bone and temporal muscle. A 45-year-old woman with a contracted eye socket underwent reconstructive surgery with a trilobed thoracodorsal artery perforator (TAP) adiposal flap with skin island. The flap was successfully transferred to expand the eye socket and augument hypoplastic facial tissue. A short pedicle TAP adiposal flap through the mid-axillary line was obtained with the patient in a supine position. The T portion of the lateral intramuscular branch was transected as a pedicle vessel and flow-through vascular anastomosis was carried out. TAP adiposal flap obtained with the patient supine is very useful for reconstruction of the eye socket, eyelid, temporal muscle, and malar tissue. The advantages of the short pedicle TAP flap are that it is minimally invasive, can be transferred with only a lateral muscular branch of the thoracodorsal system, and preserves the main trunk of the thoracodorsal artery and nerve and the branch to the serratus anterior. Flow-through vascular anastomosis is possible and the flap can be harvested without the need for secondary debulking.