Related Experiment Videos
Anatomic study of the collateral blood supply of the sternum
1Division of Plastic and Reconstructive Surgery, University of Louisville, Kentucky.
Insights
Preserving blood flow to the sternum is crucial for recovery after internal thoracic artery (ITA) bypass grafting. Ligation of ITA branches close to the source ensures vital collateral circulation to the sternum.
Area of Science:
- Anatomy
- Vascular Surgery
- Surgical Research
Background:
- The internal thoracic artery (ITA) is a critical vessel for chest wall revascularization.
- Understanding collateral circulation to the sternum is essential for successful ITA bypass grafting.
Purpose of the Study:
- To identify and characterize vascular pathways supplying the sternum after ITA mobilization.
- To inform surgical techniques for preserving sternal blood supply during ITA bypass procedures.
Main Methods:
- Microdissection of ten injected and cleared human sternal specimens.
- Identification and classification of three distinct vessel types supplying the sternum.
Main Results:
- Three types of sternal blood supply vessels were identified: sternal/perforating, sternal/intercostal, and posterior intercostal arteries.
- These vessels were more prevalent in the proximal sternum.
- The integrity of the common origins of sternal/perforating and sternal/intercostal vessels is vital for collateral function.
Conclusions:
- The study identified key collateral pathways to the sternum originating from the ITA.
- Preserving the proximal origins of these vessels is critical for maintaining sternal blood flow post-surgery.
- Recommendations are made to ligate ITA branches close to the ITA to safeguard collateral circulation.
Abstract:
A microdissection study was carried out on ten injected, cleared human sternal specimens. Three types of vessel were identified that have the potential to carry blood to the sternum after mobilization of the internal thoracic artery (ITA): (1) branches of the ITA that supply both the sternum and the pectoralis major ("sternal/perforating branches"), (2) branches of the ITA that supply both the sternum and an adjoining intercostal space ("sternal/intercostal branches"), and (3) posterior intercostal arteries that do not anastomose with an ITA branch but continue past the ITA to reach the sternum. All three types of vessel were found more frequently in the proximal than in the distal half of the sternum. For sternal/perforating and sternal/intercostal vessels to function as collaterals after ITA bypass grafting, their short common trunks of origin must remain intact. The data support the recommendation that the branches of the ITA be ligated as close as possible to the ITA itself to preserve collateral blood flow to the sternum.