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Thoracoacromial artery perforator flap: anatomical basis and clinical applications
Yi Xin Zhang1, Hu Yongjie, Caroline Messmer
1Shanghai and Changsha, People's Republic of China; Singapore; Florence and Pisa, Italy; and Philadelphia, Pa. From the Departments of Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital; Division of Head and Neck Surgery, Department of Surgery, Hunan Province Tumor Hospital; Maxillofacial Surgery Unit, Hospital of Florence; Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania; and Plastic and Reconstructive Surgery Unit, Hospital of Pisa.
Background:
Concerns and criticism have been reported on the feasibility and vascular reliability of the thoracoacromial artery perforator flap because of the inconsistent size of the pectoral branch of the thoracoacromial artery and its cutaneous perforators. The authors have investigated its vascular basis through a cadaver dissection and described their clinical experience in the surgical strategy, range of application, and indications for the thoracoacromial artery perforator flap.
Methods:
Twelve fresh human cadavers were dissected to define the anatomy of the branches of the thoracoacromial artery and their perforators and the anatomical landmarks for clinical application. Single pectoral branch perforators were injected to measure the extension of the thoracoacromial artery perforator vascular territory.
Results:
A constant thoracoacromial artery perforator was present in the septum between the clavicular and sternocostal heads of the pectoralis major muscle in 21 of 24 hemichests. The mean caliber of the perforator was 0.7 mm and the mean length of the vascular pedicle was 7.1 cm. The territory of the thoracoacromial artery perforator flap extended up to the fourth intercostal space inferiorly. Between 2006 and 2011, the thoracoacromial artery perforator flap was used to reconstruct head and neck defects in seven patients. All patients healed uneventfully.
Conclusions:
The authors' studies provide evidence of the vascular supply and the clinical application of the thoracoacromial artery perforator flap. The recruitment of the chest skin through a thoracoacromial artery perforator flap resulted in an adequate color match, texture, and pliability for local adjacent defect restoration and for head and neck reconstruction.
Clinical Question/Level Of Evidence:
Therapeutic, IV.
