Re-introducing the delto-acromial perforator flap: clinical experience and cadaver dissection

Publication date: Available online 12 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Adrian S.H. Ooi, Daniel R. Butz, Chad M. Teven, Lawrence J. Gottlieb
BackgroundAlthough perforator flaps from the pectoral branch of the thoraco-acromial (TA) axis have been well-described, there are few reports of perforator flaps based on the delto-acromial (DA) branches. We have found a reliable perforator coming off the DA branch of the TA axis, and have named a flap based on this vessel the delto-acromial perforator (DAP) flap. We describe our experience with the DAP flap together with a fresh cadaver anatomical study.MethodsA retrospective review of all DAP flaps performed between December 2012 and January 2015 at our institution, with analysis of operative details, flap characteristics and surgical outcomes. We performed fresh cadaver dissection on 5 hemi-chest walls.ResultsThe main cutaneous perforator from the deltoid and/or acromial branches is found at the delto-pectoral groove, 8cm lateral to the TA axis and 8cm inferior to the acromio-clavicular joint. Five patients underwent DAP flap reconstruction. Three were pedicled and 2 were free flaps. Average pedicle length from the origin of the DA branch was 8 cm, with an arterial diameter of at least 1 mm and vein diameter 1.5 mm. All flaps survived completely. Cadaver dissection showed a consistent perforator arising from the common delto-acromial branch in 4 cadavers, and from the deltoid branch in 1 cadaver.ConclusionsThe DAP flap is a good addition to the armamentarium of reconstructive surgeons when a relatively thin fasciocutaneous flap with minimal hair is desired. It may be used for free tissue or locoregional transfer.



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