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Routine Contrasted Chest CT Identifies the Angular Branch of the Thoracodorsal Trunk: Case Series.

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Summary

Preoperative imaging accurately identifies angular vessels for scapular flap harvest. This technique, with over 14mm of axillary fat, offers precise localization within 2mm, aiding surgical planning.

Keywords:
CT angiographyangular arteryfree flappreoperative imagingscapular free flap

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Area of Science:

  • Plastic Surgery
  • Radiology
  • Anatomy

Background:

  • The angular branch (AV) location is highly variable, posing challenges for scapular flap harvest.
  • Preoperative imaging localization could significantly enhance surgical planning and outcomes.

Purpose of the Study:

  • To evaluate the accuracy and reliability of preoperative computed tomography (CT) imaging in localizing the angular vessels for scapular flap harvest.
  • To determine the correlation between axillary fat dimensions and the ability to identify the AV.

Main Methods:

  • A retrospective surgical and radiographic case series was conducted at an academic, tertiary care center.
  • Preoperative contrasted CT scans of the chest were independently reviewed by a surgeon and radiologist for 11 patients undergoing scapular tip free flaps.
  • A larger radiographic series of 52 patients (104 sides) with contrasted CT chest was analyzed to assess AV identification and axillary fat dimensions.

Main Results:

  • In the surgical series, preoperative imaging correctly classified the AV location in 9 out of 11 patients, with substantial agreement between readers and surgical findings (κ = 0.718-0.735) and a maximum deviation of 2mm.
  • In the radiographic series, the AV was not identified in only 3.8% of sides, all of which had an axillary fat pad less than 14mm in transverse dimension.
  • The accuracy of AV identification was high in patients with adequate axillary fat (over 14mm).

Conclusions:

  • Standard preoperative CT imaging is a valuable tool for identifying angular vessels with high accuracy (within 2mm) in patients with sufficient axillary fat (over 14mm transverse measurement at the third rib).
  • This imaging-guided localization can improve the precision and success of scapular flap harvests.