Thoracic perforators (IMAP, LICAP, DICAP) for P-to-P and perforator flaps - analysis of localization and anatomy...

Perforator-to-perforator (P-to-P) free flaps and local to regional perforator flaps are increasingly important in thoracic reconstructive surgery. However, limited anatomical and imaging data on internal mammary (IMAPs), lateral (LICAPs), and dorsal intercostal artery perforators (DICAPs) hinder presurgical planning and clinical use. This study aimed to evaluate the feasibility of computed tomography angiography (CTA) for thoracic perforator mapping.

Non-ECG triggered CTAs of the thoracoabdominal aorta of patients with suspected aortal pathology were retrospectively reviewed. After applying exclusion criteria (aortal pathology, major hardening artifacts, aortal stent prothesis, anasarca or other thoracic wall pathology), absolute count, localization and diameter of thoracic perforators were analyzed for 150 patients (age: 67.3 ± 15.11, m = 99, f = 51) using integrated imaging software.

Using CTA, IMAPs were detected in 99 % of patients, with a mean count of 3.35 ± 1.30 per patient, typically located in the 3.35 ± 1.30 intercostal space (ICS) and having a mean diameter of 1.41 ± 0.35 mm. LICAPs were present in 91 % of patients, averaging 3.46 ± 1.93 per patient, found in the 9.83 ± 1.41 ICS with a mean diameter of 1.26 ± 0.30 mm. DICAPs were identified in 87 % of patients, with an average of 2.71 ± 1.64 per patient, typically located in the 7.49 ± 2.27 ICS and having a mean diameter of 1.25 ± 0.31 mm.

CTA is capable of non-invasive in vivo anatomical mapping of IMAPs, LICAPs and DICAPs and thus has the potential to guide state-of-the-art plastic surgery.