Table 2.

Intraoperative Characteristics

Authors	Preoperative Assessment	Patient Positioning	Flap Design	Dissection	Flap Size	Perforators	Operative Time
Hamdi et al,18 2004	DopplerPinch test	Lateral decubitus position with 90 degree of shoulder abduction and 90 degree of elbow flexion	Extended over the anterior border of the LD muscleOblique upward or transversal	Dissection bevelled to include a maximum of fat Flap elevation starts from anterior and caudal border Nerve branches preserved Dissection above the fascia The TD vessels are dissected proximally until their origin Only when the dissection of the vessels is complete, the skin paddle can be raised from the LD muscle When tiny perforators are found, an MS technique is used	20 × 8 cm (length 16–25/width 6–10 cm)	Pulsating and >0.5 cmOriginating from the descending branch preferentially 13 → 1 perforator 5 → 2 perforators	2.5 h (1.5–3 h)
Ortiz et al,23 2007	Echo Doppler	Lateral position, leaving the upper limb in neutral abduction	Central point located 8 cm below the posterior axillary fold and 2 cm behind the anterior border of the LD muscle	Desepidermization of the skin area before the raising of the flapFlap elevation starts from anterior borderSubfascial dissection (after dissection, limit the amount of fascia up to 1 cm around perforator)Nerve branches preservedFlap is tunneled in every case toward the defectVessel dissection until enough length is achieved to allow insetting of the flap in the breast defect without tension	21 × 8 cm	7 → 1 perforator1 → 2 perforators	—
Hamdi et al,24 2008	—	—	—	—	—	—	—
Hamdi et al,25 2008	Unidirectional Doppler probe (8 Hz) simulate operative positioning	Lateral decubitus position with 90 degree of shoulder abduction and 90 degree of elbow flexion	Extended over the anterior border of the LD muscleOblique upward or transversal	Flap elevation starts from anterior and caudal borderNerve branches preservedDissection above the fasciaThe TD vessels are dissected proximally until their originOnly when the dissection of the vessels is complete, the skin paddle can be raised from the LD muscleFlap is pulled through the muscle and transposed into the defectPartial or total deepithelization (flap can be folded to increase projection)When tiny perforators are found, an MS technique is used	20 × 8 cm 16–25/6–10	Pulsating and >0.5 cmOriginating from the descending branch preferentially89 → 1 perforator7 → 2 perforators90 → from the descending branch6 → from the transverse branch2 → direct septal perforator	Harvesting time = 80′ (25′–120′)
Yang et al,26 2012	—	Lateral decubitus position	Oblique downward	—	—	—	—
Kijima et al,27 2013	—	—	TDAP cutaneous flap with a crescent-shaped dermis	Tumor resection via an incision at the anterior axillary line (lazys-shaped, s-shaped ellipse, or leaf-shaped incision if skin was included in the resection)Crescent-shaped dermis TDAP flap involved 5 steps:1. Formation of a de-epithelialized crescent of skin along the incision line2. Raising a C-shaped cutaneous flap of fat attached to the fascia of the LD3. Rotation of the flap into the defect4. Trimming or gathering the flap to adjust it to the shape of the contralateral breast5. Fixing the flap to the edge of the remaining breastIndocyanine green angiography	—	—	Total = 127′Reconstruction = 62′Control group: Total = 169′Reconstruction = 51′
Lee et al,28 2014	Pinch test	—	Transversally oriented	—	—	—	—
Jacobs et al,29 2015	Doppler	Lateral decubitus position	Extended over the anterior border of the LD muscleOblique downward oblique	Flap raised in an extended version incising the skin paddle to the deep fascia in a beveled angle to harvest more subcutaneous tissue and fascia than skinPerforator was not skeletonized, and the muscle fibers surrounding were left undissectedAt times, a limited back-cut into the anterior border of the LD inferior to the perforator was helpful to facilitate the rotation.The flap was either rotated 140 degree to 160 degree as a propeller to the anterior thorax or completely deepithelialized and turned over to be buried (flipover design)	From 7 × 21 to 11 × 37 cm	Originating from the descending branch preferentially 1, 2, or 3	200′ (60′–485′)
Kim et al,30 2017	3D Chest computed tomography angiographyPinch test	Lateral decubitus position	Transversally or vertically oriented (in consultation with the patient)	Dissection until enough length is achieved to allow insetting of the flap in the breast defect without tension	6 × 14.2Range: 4 × 12 to 8 × 18	—	267.3′ ± 35.3′
Amin et al,31 2017	Doppler	Lateral decubitus position	Transversally oriented	At least 1 perforator or 2 are present, in 80% of cases, in a quadrant formed through the intersection of four lines:Two horizontal lines 9 and 11 cm downward from the level of the posterior axillary fold with the arm abducted 90 degrees andTwo vertical lines 1 and 4 cm medial to the anterior border of LD	18 × 9 cmLength range: 14–23 cmWidth range: 7–12 cm	2 → TDAP38 → MS-LD I	227′ (310′–180′)
Youssif et al,32 2019	DopplerPinch test	Lateral decubitus position	Extended over the anterior border of the LD muscleTransversally oriented	6 → TDAP20 → MS-LD IITunnel from the donor site to the breast approximately at 4 o′clock position to inset the flap (allows preservation of the natural lateral breast borders with no disruption of the axillary silhouette)	Max: 9 × 21 cm	—	—
Abdelrahman et al,33 2019	Doppler Pinch test	Lateral decubitus position	Extended over the anterior border of the LD muscle Transversally oriented	Dissection was beveled outward to include the maximum fat, beginning from the anterior side along the suprafascial planeWhen the anterior border of the muscle was reached, a tunnel was created under the lateral breast mound and lateral thoracic wallVascular pedicle was dissected until enough length was achieved to allow insetting of the flap in the breast defect without tension	—	—	155.7′ ± 9.26′

3D, 3 dimensional; TD, thoracodorsal.