Case Report Highlights Zero-CO₂ Endoscopic TDAP Flap for Breast Reconstruction Salvage
Key Takeaways
- A case report describes successful salvage breast reconstruction using a computed tomographic angiography (CTA)-guided endoscopic thoracodorsal artery perforator (TDAP) flap after complete deep inferior epigastric perforator (DIEP) flap loss.
- The procedure was performed through a single 8-cm posterior axillary incision without CO₂ insufflation and resulted in complete flap survival with minimal donor-site morbidity.
- The authors suggest the technique may offer a practical reconstructive option for centers without access to standard endoscopic insufflation equipment, although evidence is currently limited to a single case report.
A computed tomographic angiography (CTA)-guided endoscopic thoracodorsal artery perforator (TDAP) flap harvested without carbon dioxide (CO₂) insufflation successfully salvaged breast reconstruction following complete deep inferior epigastric perforator (DIEP) flap loss in a recently published case report in Plastic and Reconstructive Surgery Global Open.
Minimally Invasive Salvage Option After DIEP Flap Failure
The report describes a 47-year-old woman who experienced total necrosis of a free DIEP flap after autologous breast reconstruction. Because salvage options can be limited in patients with low body mass index, particularly in Asian populations, the surgical team selected a pedicled TDAP flap guided by preoperative CTA.
Using a single 8-cm posterior axillary incision, surgeons skeletonized the thoracodorsal artery perforator pedicle endoscopically while minimizing muscle harvest. The procedure was completed without CO₂ insufflation, eliminating the need for standard insufflation equipment.
The flap survived completely, with no reported postoperative seroma or shoulder dysfunction. At 6-month follow-up, the donor-site scar remained inconspicuous and functional outcomes were preserved.
The authors noted that combining CTA with gasless endoscopic harvest facilitated accurate perforator identification while minimizing donor-site morbidity. They suggest the approach may be particularly useful in institutions where access to conventional endoscopic insufflation systems is limited.
As a single-patient case report, the findings are descriptive and cannot establish comparative safety or effectiveness. Larger studies will be needed to determine whether this technique can be reproduced across broader patient populations and clinical settings.
"This case demonstrates that computed tomographic angiography-guided endoscopic TDAP flap harvest without CO₂ insufflation is a practical, low-morbidity salvage option after microsurgical failure and is particularly suitable for Asian centers with limited access to standard insufflation equipment," the authors wrote.
Source
Mizuno S, Hayashi A, Hayashi N. Computed tomographic angiography-guided zero-CO₂ endoscopic thoracodorsal artery perforator flap for salvage breast reconstruction after deep inferior epigastric perforator flap loss. Plast Reconstr Surg Glob Open. 2026;14(7):e7918. doi:10.1097/GOX.0000000000007918.