Background: The latissimus dorsi flap was first described by Tansini and the thoracodorsal artery perforator flap was first described by Angrigiani in the reconstruction of the chest wall defects.The versatility of pedicled flaps based on thoracodorsal system have several advantages that make them a workhorse flaps for most reconstructions requiring soft tissue cover.

Aim: We will show our experience with pedicled flaps based on the thoracodorsal system in the reconstruction of defects of the chest wall, shoulder and axilla.

Methods: We have performed a total of 38 flaps over a period from March 2014 to February 2020 at Department of Plastic and Reconstructive Surgery, University Hospital Foca, Bosnia and Herzegovina and Department od Plastic and Reconstructive Surgery, Al Emadi Hospital, Doha, Qatar. The patients had defects of the chest wall, axilla and shoulder after tumor excisions, infection and trauma. The defects were closed with latissimus dorsi flap in 21 patients while in 17 patients we used thoracodorsal artery perforator flap.

Results: We had neither any failures nor any re-explorations. We had seroma of the donor area in 6 patients. The donor area was closed directly in all patients.  

Conclusion:The pedicled flaps based on thoracodorsal system are reliable for the reconstruction of chest wall, axilla and shoulder defects. The adventages of these flaps are easy dissection, wide arch rotation and minimal donor side morbidity.

Introduction

Asian blepharoplasty on eyelid surgery is a procedure performed in people of Oriental descent. In these people who come in from the North East part of India China Korea Japan, they do not have the eyelid fold and the eyes appear a little small as compared to other people. Essentially there is nothing wrong in their eyes and it is a developmental error that has now become genetic. 

Cause

The lack of the fold is very simple to understand. There is a muscle inside the upper eyelid skin which is known as the levator palpebrae superioris. In people who have a fold there are some muscles slips which pass from the muscle to the skin. So whenever there is a contraction of the upper eyelid which is the prime action of this muscle this lips also contract and pull the skin in words with every eye opening. Opening the eye is the prime action of this muscle. In people of Oriental Descent this slip of muscle is absent and often there is more fat accumulated in the layers of the skin than compared to other people. This appears to give a slightly Puffy appearance to the upper eyelid. 

Assessment 

•  we need to access for any existing ptosis. Since the eyes  may be a little smaller in these patients it is a relatively difficult task to assess for ptosis.
• Assess any extra fat

Treatment 

The only option for creating an upper eyelid fold is either a surgical Asian blepharoplasty procedure or a non surgical suture based blepharoplasty procedure. We do not believe in the suture procedure since there is a higher rate of recurrence and the results are not permanent. Asian blepharoplasty or double eyelid surgery has performed by us is a very reliable procedure with hundred percent results and satisfaction.