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

The location of the angular branch is highly variable. Preoperative imaging localization could provide clinical value in scapular flap harvest.

Surgical and radiographic case series at an academic, tertiary care center.

Eleven consecutive patients undergoing scapular tip free flaps between 8/2020 and 3/2021. The surgeon and radiologist independently reviewed contrasted computed tomography (CT) of the chest preoperatively. Radiographic findings were compared to surgical findings.

Fifty-two patients (104 sides) with contrasted CT chest between 10/2019 and 10/2020 were reviewed by the surgeon and radiologist. Data was recorded as with the surgical series. Axillary fat dimension was recorded.

Surgical case series: Nine patients were correctly classified by both readers, giving 81.8% agreement between readers and surgical findings. This equated to a substantial level of agreement for readers relative to surgical findings (κ = 0.718-0.735). Maximum deviation was 2 mm from the surgical findings. Radiographic series: One or both readers were unable to identify the AV on 4/104 sides (3.8%). All four sides had an axillary fat pad of less than 14 mm measured in the transverse dimension. Two of the remaining 100 sides where the AV was identified were under 14 mm.

Standard preoperative imaging can identify the angular vessels at a high rate in patients with more than 14 mm of fat in a transverse measurement at the third rib. The accuracy of the localization is within 2 mm and was confirmed surgically.