Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern

Tashiro, Kensuke; Harima, Mitsunobu; Mito, Daisuke; Shibata, Takashi; Furuya, Megumi; Kato, Motoi; Yamamoto, Takumi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

doi:10.1016/j.bjps.2015.02.011

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…Taylor and Daniel reported an absence of the lateral thoracic artery in three out of 20 dissections, and Harii et al could not find it in two out of 11 clinical cases. More recently, Tashiro et al employed 27 lateral thoracic artery‐based flaps for lower limb reconstruction and divided its branches into three groups: a superficial, a medial, and a deep one . We think that these three groups of branches might correspond to the superficial thoracic artery, a musculocutaneous perforator, and the lateral thoracic artery itself, respectively, as described by Adachi et al In Tashiro's series, the deep branch, alias the lateral thoracic artery, was missing in five out of 27 cases.…”

Section: Discussionmentioning

confidence: 91%

“…Because other authors applied preoperative ultrasound for lymph node count, this information should be good enough for flap planning. Furthermore, in case of the thoracic lateral VLNT, colour doppler ultrasound can be employed to obtain preoperative data regarding location, course, and diameter of the lateral thoracic artery and its perforators …”

Section: Discussionmentioning

confidence: 99%

“…lateral thoracic artery-based flaps for lower limb reconstruction and divided its branches into three groups: a superficial, a medial, and a deep one. 22 We think that these three groups of branches might correspond to the superficial thoracic artery, a musculocutaneous perforator, and the lateral thoracic artery itself, respectively, as described by Adachi et al 20 In Tashiro Therefore, we either suggest to anastomose and include an additional lateral thoracic artery as perfusion backup, if present, or not to include the skin paddle if skin perfusion is poor after microvascular transfer.…”

Section: Perfusion Studymentioning

confidence: 91%

“…Furthermore, in case of the thoracic lateral VLNT, colour doppler ultrasound can be employed to obtain preoperative data regarding location, course, and diameter of the lateral thoracic artery and its perforators. 22…”

Section: Perfusion Studymentioning

confidence: 99%

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The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

Tinhofer

Meng

Steinbacher

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Perfusion Studymentioning

confidence: 91%

Section: Perfusion Studymentioning

confidence: 99%

See 2 more Smart Citations

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

Tinhofer

Meng

Steinbacher

et al. 2017

Journal of Surgical Oncology

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“…There have been several reports regarding flaps utilizing a sole LTAP, which mentioned that the perfusion area of the LTAP was located more anterior to that of the TDA [ 8 , 9 , 17 , 27 ]. In addition, the LTA and LTV are anatomically complicated and have much variation, and they usually run separately in the proximal region; however, distally, they run together at the perforator level [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

The concept of “whole perforator system” in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series

Kagaya¹,

Arikawa²,

Sekiyama³

et al. 2021

PLoS ONE

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Background Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new “whole perforator system” (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner. Methods We first performed an anatomical study that verified the number and perforating points of all perforators around the LD lateral border using the results of dynamic contrast-enhanced magnetic resonance imaging of patients with breast cancer. Following the anatomical evaluation, we performed large muscle-preserving flap transfer that contained all of the perforators around the LD lateral border in an actual clinical setting. Results A total of 175 latissimus dorsi from 98 patients were included. The mean number of perforators (TDAP-sc + TDAP-mp + LTAP) per side was 4.51±1.44 (2–9); TDAP-sc was present in 57.1% (100/175) of cases, and TDAP-mp in 76.6% (134/175); the TDAP total prevalence rate (TDAP-sc + TDAP-mp) was 96.0% (168/175). The LTAP existence rate was 94.3% (165/175). Distance from the axillary artery to the TDAP-sc was 148.7±56.3 mm, which was significantly proximal to the TDAP-mp (183.8±54.2 mm) and LTAP (172.2±81.3 mm). Conclusion The lateral thoracic region has an abundant cutaneous perforator system derived from the descending branch of the thoracodorsal and lateral thoracic arteries. Clinical application of the lateral thoracic WPS flap is promising, with a large survival area even with muscle-preserving procedures and requiring a relatively simple procedure.

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Investigation of flow velocity in recipient perforator artery for a reliable indicator for the flap transfer with perforator to perforator anastomosis

et al. 2021

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Introduction: In flap transfer with perforator to perforator anastomosis (FTPPA), encountering poor pulsation and blood flow in a recipient perforator intraoperatively often makes FTPPA impossible. This study sought to identify color and spectral Doppler ultrasonography (CSDUS) parameters that can aid reliable preoperative selection of a recipient perforator artery.Patients and Methods: The study enrolled 38 patients with lower extremity lymphedema who underwent vascularized lymphatic tissue transfer with perforator to perforator anastomosis for physiological lymphatic flow reconstruction. In all cases, three candidate recipient perforators were searched in each lower extremities, and vessel diameter and peak systolic flow velocity (PSFV) were measured. The inclusion criteria for candidates were a vessel diameter of >0.5 mm and a PSFV of >10 cm/s. These measures were compared with intraoperative findings, diameters and if there was pulsation and visible spurting evident.Results: A total of 114 candidates were selected, and 52 of the candidates were dissected until suitable perforators were found. PSFV (cm/s) on CSDUS was ≥20.0 in 32 perforators (84.2%) and was 15.0-19.9 in 6 perforators (15.8%) in the group with pulsation and visible spurting evident, and 15.0-19.9 in one perforator (7.1%) and ≤ 14.9 in 13 perforators (92.9%) in the group without pulsation and visible spurting evident. There was a statistically significant correlation between preoperative PSFV and intraoperative pulsation and visible spurting evident after dissection (P = 0.021 Â 10 À3 ). The flap survival rate was 92.1%. Conclusion:PSFV is an important preoperative determinant of the suitability of a recipient perforator artery for FTPPA.

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Preoperative color Doppler ultrasound assessment of the lateral thoracic artery perforator flap and its branching pattern

Cited by 11 publications

References 14 publications

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

The surgical anatomy of the vascularized lateral thoracic artery lymph node flap—A cadaver study

The concept of “whole perforator system” in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series

Investigation of flow velocity in recipient perforator artery for a reliable indicator for the flap transfer with perforator to perforator anastomosis

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