Perforator flaps based on the pectoral branch of the thoracoacromial artery: anatomical basis using 24 dissections

Year 2023, Volume: 17 Issue: 1, 13 - 21, 30.04.2023

Philippe Manyacka Ma Nyemb Christian Fontaine Véronique Duquennoy-martinot Xavier Demondion

Abstract

Objectives: A perforator flap based on the pectoral branch of the thoracoacromial artery (TAA) is an attractive option, both in terms of the regional coverage possibilities and the reduced donor site morbidity. And yet this technique has been little documented in the literature. The authors report a series of dissections in order to understand the realization and the indications of this surgical technique.
Methods: We dissected 24 perforator flaps based on the pectoral branch of the TAA in cadaver specimens preserved in a glycerin-rich, formalin-free solution. The TAA was first injected with methylene blue. The vascular territory, location of perforators relative to known landmarks, along with the flap’s potential amplitude and arc of rotation were studied.
Results: The main perforator arteries were in the middle of the deltopectoral groove length; they were surrounded by adipose tissue in 80% of specimens. Two perforator arteries were found in two specimens: one was in the middle of the deltopectoral groove length and the other was more proximal. The flap’s arc of rotation made it possible to reach the anterior cervical region, the sternal region and the axillary region in every specimen.
Conclusion: Through an anatomical study of perforator flaps based on the TAA, we reviewed the principles and landmarks that can be used by plastic surgeons to easily carry out this surgical technique.

Keywords

dissection, pectoral branch, perforator flap, thoracoacromial artery

References

• Bakamjian VY. Total reconstruction of pharynx with medially based deltopectoral skin flap. NY State J Med 1968;68:2771–8.
• Ariyan S. The pectoralis major myocutaneous flap: a versatile flap for reconstruction in the head and neck. Plast Reconst Surg 1979;63:73–81.
• Morris SF, Tang M, Almutari K, Geddes C, Yang D. The anatomic basis of perforator flaps. Clin Plast Surg 2010;37:553–70.
• Song D, Pafitanis G, Pont LEP, Yang P, Koshima I, Zhang Y, Iida T, Zhou X, Li Z. Chimeric thoracoacromial artery perforator flap for one‐staged reconstruction of complex pharyngoesophageal defects: a single unit experience. Head Neck 2018;40:302–11.
• Zhang YX, Li Z, Grassetti L, Lazzeri D, Nicoli F, Zenn MR, Zhou X, Spinelli G, Yu P. A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions. Laryngoscope 2016;126:1315–20.
• Geddes CR, Tang M, Yang D, Morris SF. An assessment of the anatomical basis of the thoracoacromial artery perforator flap. Can J Plast Surg 2003;11:23–7.
• Hallock GG. The island thoracoacromial artery muscle perforator flap. Ann Plast Surg 2011;66:168–71.
• Reid CD, Taylor GI. The vascular territory of the acromiothoracic axis. Br J Plast Surg 1984;37:194–212.
• Kiyokawa K, Tai Y, Tanabe HY, Inoue Y, Yamauchi T, Rikimaru H, Mori K, Nakashima T. A method that preserves circulation during preparation of the pectoralis major myocutaneous flap in head and neck reconstruction. Plast Reconstr Surg 1998;102:2336– 45.
• Rikimaru H, Kiyokawa K, Inoue Y, Tai Y. Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap. Plast Reconstr Surg 2005;115:1342–52.
• Serafin D. Atlas of microsurgical composite tissue transplantation. Philadelphia (PA): WB Saunders; 1996. p. 813.
• Wei WI, Chan YW. Pectoralis major flap. In: Wei FC, Mardini S, editors. Flaps and reconstructive surgery. 1st ed. Philadelphia (PA): WB Saunders; 2009. p. 175–92.
• Kosutic D, Krajnc I, Pejkovic B, Anderhuber F, Solman L, Djukic E, Solinc M. Thoraco-acromial artery perforator ‘propeller’ flap. J Plast Reconstr Aesthet Surg 2010;63:e491–3.
• Nishi Y, Rikimaru H, Kiyokawa K, Watanabe K, Koga N, Sakamoto A. Development of the pectoral perforator flap and the deltopectoral perforator flap pedicled with the pectoralis major muscle flap. Ann Plast Surg 2013;71:365–71.
• Okada M, Ikeda M, Uemura T, Takada J, Nakamura H. A propeller flap based on the thoracoacromial artery for reconstruction of a skin defect in the cervical region: a case report. J Plast Reconstr Aesthet Surg 2013;66:720–2.
• Zhang YX, Yongjie H, Messmer C, Ong YS, Li Z, Zhou X, Spinelli G, Agostini T, Levin LS, Lazzeri D. Thoracoacromial artery perforator flap: anatomical basis and clinical applications. Plast Reconstr Surg 2013;131:759e–70e.
• Wong C, Saint-Cyr M, Rasko Y, Mojallal A, Bailey S, Myers S, Rohrich RJ. Three-and four-dimensional arterial and venous perforasomes of the internal mammary artery perforator flap. Plast Reconstr Surg 2009;124:1759–69.
• Salmon M, Grégoire R. Artères de la peau (Vol. 4). Paris: Masson; 1936. p. 123–131.
• Salmon M, Dor J. Les artères des muscles des membres et du tronc. Paris: Masson; 1933. p. 238.
• Schellekens PPA, Paes EC, Hage JJ, van der Wal MBA, Bleys RLAW, Kon M. Anatomy of the vascular pedicle of the internal mammary artery perforator (IMAP) flap as applied for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2011;64:53–7.
• Vesely MJJ, Murray DJ, Novak CB, Gullane PJ, Neligan PC. The internal mammary artery perforator flap: an anatomical study and a case report. Ann Plast Surg 2007;58:156–61.