FUNCTIONAL OUTCOME COMPARISON OF THORACODORSAL ARTERY PERFORATOR FLAP AND CIRCUMFLEX SCAPULAR ARTERY PERFORATOR FLAP IN AXILLARY DEFECTS

Abstract

Background: Axillary defects arise following trauma, oncological excision, infection, or postburn contracture and result in functional limitation of the shoulder joint in addition to aesthetic impairment. Reconstructive management requires a balance of durable coverage, minimal donor site morbidity, and restoration of shoulder biomechanics. Among various reconstructive strategies, perforator-based flaps such as the thoracodorsal artery perforator flap and circumflex scapular artery perforator flap have shown promising outcomes.

Objective: To compare the excellent functional outcome of thoracodorsal artery perforator flap and circumflex scapular artery perforator flap in the management of axillary defects.

Study design: Comparative study.

Duration and place of study: The study was conducted from June 2024 to  May 2025 in the Department of Plastic Surgery, Fauji Foundation Hospital, and Rawalpindi.

Methodology: Seventy-eight patients aged 20 to 65 years presenting with axillary defects requiring flap coverage were enrolled and randomized into two groups of 39 patients each. In the thoracodorsal artery perforator flap group, the flap was elevated along the lateral border of the latissimus dorsi and inset in a propeller fashion, while in the circumflex scapular artery perforator flap group, dissection was performed medial to the scapular border and rotation up to 160 degrees achieved coverage.

Results: At six months, mean Constant–Murley Scores were higher in the thoracodorsal artery perforator flap group (87.78 ± 9.46) compared with the circumflex scapular artery perforator flap group (84.19 ± 10.94). Excellent functional outcomes were achieved in 71.8% and 51.3% of patients respectively, although the difference did not reach statistical significance. The TDAP group had a significantly longer operative time (190.79 ± 28.77 min) but a shorter hospital stay (4.38 ± 1.57 days) compared to the CSAP group (121.51 ± 28.37 min and 6.18 ± 3.21 days). Axillary contour assessment revealed a better aesthetic outcome in the CSAP group, which demonstrated fewer contour deformities (bulge >1cm} observed in 10.3 % of patients) and better adduction clearance (unsatisfactory clearance in 7.7% of patients) compared to the TDAP group (bulge >1 cm in 20.5 % and unsatisfactory clearance in 17.9% of patients).

Conclusion: Both flap techniques provide effective and reliable reconstruction for axillary defects.