An Anatomical Study of Posterior Trunk Recipient Vessels, and Comparisons of Outcome following Pedicled- and Free-Flap Transfers for Treatment of Sarcoma in the Posterior Trunk

Abstract

Background Reconstruction after wide resection of a large sarcoma arising in the posterior trunk may require free-flap transfer to reduce the postoperative complications. Here, we describe the recipient vessels on the whole posterior trunk. Moreover, to show the reliability of these vessels, we describe an institutional series of free-flap reconstruction. Methods In the cadaveric study, 20 posterior trunk regions from 10 fixed cadavers were dissected. The location and the diameter of the perforating artery and vein on the posterior were documented. In the clinical study, 54 patients undergoing immediate reconstruction surgery with only a pedicled flap (n = 45) and with a free flap (n = 9) after sarcoma resection on the posterior trunk between July 2005 and September 2021 were identified. One-to-one propensity score matching was performed to compare the postoperative complications. Results In the cadaveric study, a total of 178 perforators were identified. The average diameter of the superficial cervical artery (SCA) and vein, dorsal scapular artery (DSA) and vein, medial branch of dorsal intercostal artery perforator (m-DICAP) and vein, lateral branch of dorsal intercostal artery perforator (l-DICAP) and vein, and dorsolateral intercostal artery perforator (DLICAP) and vein were 1.03, 1.67, 1.38, 1.84, 1.28, 1.84, 1.01, 1.60, 1.11, and 1.70 mm. In the clinical study, the propensity score-matched analysis involving eight pairs showed a significantly higher occurrence of total complications in the pedicled-flap group than the free-flap group (62.5 vs. 0%, p = 0.03). Conclusion The cadaveric study showed that the perforators from the SCA, DSA, and posterior intercostal artery are constantly present. The clinical study demonstrated the feasibility and reliability of a free-flap transfer.

Origin variations and brachial plexus relationship of the dorsal scapular artery

“…Variations in the origin and course of arteries around the brachial plexus are of immense value to surgeons, angiographists, and anatomists. For example, the pedicled DSA flaps are widely used for reconstruction of head, neck, and upper back defects 12 , 13 . Sufficient perfusion in the distal region determined the flap survival rates and therefore the outcome of the surgery.…”

Usefulness of Harmonic ACE+7 Scalpel in Breast Reconstruction with Extended Latissimus Dorsi Flap: An Open-label Single Institution Pilot Study

“…11 In ELD surgery, which requires dissection of the fat layer above the superficial fascia over a wider area than normal LD, we considered this to be advantageous because it is easier to maintain a constant layer of dissection in the physical curve around the lumbar area. The diameter of the intercostal artery perforating branch, one of the most significant elements of postoperative hematoma, is 1-2 mm, 25 and sealing this branch allows for the operation to progress without thread ligation. A marked reduction in operative time and blood loss was observed during flap elevation in the group operated on using the Harmonic ACE+7.…”

“…The diameter of the intercostal artery perforating branch, one of the most significant elements of postoperative hematoma, is 1–2 mm, 25 and sealing this branch allows for the operation to progress without thread ligation. A marked reduction in operative time and blood loss was observed during flap elevation in the group operated on using the Harmonic ACE+7.…”