The value of preoperative computed tomography angiography (CT-A) in patients undergoing delayed latissimus dorsi flap breast reconstruction after axillary lymph node dissection or irradiation and suspicion of pedicle injury

Mayer, Horacio F.; Buena, Ignacio Piedra; Petersen, María Laura

doi:10.1016/j.bjps.2020.08.096

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…We collected preoperative chest CT angiography results of patients who were candidates for LD flap breast reconstruction following full mastectomy for breast cancer. We analyzed the collected data and have reported on patterns of the thoracodorsal artery and its branches by identifying the vascular anatomy of the axillary artery and its branches 6,7,24 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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BACKGROUND The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest CT angiography. PATIENTS AND METHODS We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. RESULTS 700 blood vessels were classified according to the KNUPS TDA classification, 388 (185 Rt. and 203 Lt.), 126 (64 Rt. and 62 Lt.), 91 (49 Rt. and 42 Lt.), 57 (27 Rt. and 30 Lt.), and 38 (25 Rt. and 13 Lt.) vessels were classified as Type I, II, III, IV, and V, respectively. Among 350 patients, 205 patients showed matching types for Lt. and Rt. vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with Type I, II, III, IV, and V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with Types I+II, I+III, I+IV, I+V, II+III, II+IV, II+V, III+IV, III+V, and IV+V, respectively. CONCLUSIONS While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…We analyzed the collected data and have reported on patterns of the thoracodorsal artery and its branches by identifying the vascular anatomy of the axillary artery and its branches. [13][14][15]…”

mentioning

confidence: 99%

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Lee

Cho

Kang

et al. 2023

J Reconstr Microsurg

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Thoracodorsal Artery Flap: Latissimus Dorsi Flap

Farid

Nikkhah

Rawlins

2023

Core Techniques in Flap Reconstructive Microsurgery

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Management after flap failure: a narrative review

Myers¹,

Tang²,

Saad³

et al. 2023

Plast Aesthet Res

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Autologous free tissue transfer for breast reconstruction is a well-established and reliable form of reconstruction for women undergoing mastectomies. These surgeries are performed with high rates of success; however, the consequences of flap failure can be devastating to patients and surgeons. Breast reconstruction decision making following flap loss is a uniquely individualized process, based on considerations of safety, patient goals and preferences, as well as the surgeon’s skillset. The first priority following flap failure is to provide thoughtful patient counseling and support through this difficult time. The aims of reconstruction salvage after flap loss are to excise unhealthy tissue and restore a breast mound of normal anatomical shape. We present an algorithm as a possible approach to managing flap failures. We also review the management of breast reconstruction following free flap failure, including the role of hematologic investigation, anticoagulation recommendations and secondary or tertiary reconstruction with both prosthetic and autologous techniques.

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The value of preoperative computed tomography angiography (CT-A) in patients undergoing delayed latissimus dorsi flap breast reconstruction after axillary lymph node dissection or irradiation and suspicion of pedicle injury

Cited by 3 publications

References 5 publications

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Thoracodorsal Artery Flap: Latissimus Dorsi Flap

Management after flap failure: a narrative review

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