One-stage transfer of 2 paddles of thoracodorsal artery perforator flap with 1 pair of vascular anastomoses for Barraquer-Simons syndrome.

We report a novel technique: a 1-stage transfer of 2 paddles of thoracodorsal artery perforator (TAP) flap with 1 pair of vascular anastomoses for simultaneous restoration of bilateral facial atrophy. A 47-year-old woman with a severe bilateral lipodystrophy of the face (Barraquer-Simons syndrome) was surgically treated using this procedure. Sufficient blood supply to each of the 2 flaps was confirmed with fluorescent angiography using the red-excited indocyanine green method. A good appearance was obtained, and the patient was satisfied with the result. Our procedure has advantages over conventional methods in that bilateral facial atrophy can be augmented simultaneously with only 1 donor site. Furthermore, our procedure requires only 1 pair of vascular anastomoses and the horizontal branch of the thoracodorsal nerve can be spared. To our knowledge, this procedure has not been reported to date. We consider that 2 paddles of TAP flap are safely elevated if the distal flap is designed on the descending branch, and this technique is useful for the reconstruction of bilateral facial atrophy or deformity.