The perforator flap poses a potential number of problems; spasm, kinking, injury of perforators etc., though it is a less invasive method of reconstruction. The muscle-sparing thoracodorsal artery perforator (TDAP) and the lateral thoracic branch-based conjoined flap was harvested. This conjoined flap has two different types of vascular systems; perforators of the descending branch of the thoracodorsal vessels and the direct cutaneous vessels of the lateral thoracic vessels (LTA/V). We can take advantage of these two different vascular systems by vascular augmentation using the LTA/V or conversion into the mosaic type flap with anastomoses between the LTA/V and the serratus branches of the thoracodorsal vessels, in case of vascular compromise. We have successfully managed to salvage a flap with venous congestion without any necrosis using the super-drainage procedure. This “insurance”; the muscle-sparing TDAP and lateral thoracic branch-based conjoined flap can be a great safety net in case of vascular trouble with a small premium of only an additional ten minutes of dissection for the lateral thoracic vessels. This is particularly important when you have to rely on tiny perforators.
