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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 computed tomography (CT) angiography. 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 A total of 700 blood vessels were classified according to the Kyungpook National University Plastic Surgery-Thoracodorsal Artery (KNUPS-TDA) classification: 388 (185 right and 203 left), 126 (64 right and 62 left), 91 (49 right and 42 left), 57 (27 right and 30 left), and 38 (25 right and 13 left) vessels were classified as type I, type II, type III, type IV, and type V, respectively. Among 350 patients, 205 patients showed matching types for left and right 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, type II, type III, type IV, and type 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 type I + type II, type I + type III, type I + type IV, type I + type V, type II + type III, type II + type IV, type II + type V, type III + type IV, type III + type V, and type IV + type V, respectively. Conclusion 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. [ABSTRACT FROM AUTHOR]

Nous présentons ici le cas d'un patient de 38 ans ayant bénéficié d'une phalloplastie faite par lambeau perforant thoracodorsal avec conformation par enroulement en double tube. Alors que la chirurgie de reconstruction de verge a vu une efflorescence de différentes techniques opératoires, la chirurgie de réassignation femme-homme qui en découle voit ces procédés se résumer a deux ou trois options. Si le temps préopératoire fait classiquement l'objet d'une discussion avec le patient d'un allongement des voies urinaires ou non ou encore d'une implantation secondaire ou non, le choix du site donneur reste trop systématisé. Le prélèvement d'un lambeau n'est pas sans risque. L'attention est trop souvent portée sur le site reconstruit au détriment du site prélevé. Dans le cas présent, la laxité de la région dorsale avec possibilité de fermeture directe nous a fait retenir le prélèvement d'un lambeau perforant thoraco dorsal. La fonction musculaire du site donneur est préservée et l'aspect esthétique affiné par fermeture directe. La finesse du lambeau obtenu a permis la conformation par enroulement en double tube tel que décrit par Chang. La revue de la littérature rapporte un cas de phalloplastie par lambeau perforant thoracodorsal avec allongement des voies urinaires par greffe. Aucun cas n'est décrit avec conformation en double tube à notre connaissance. This article deals with a clinical case of a tube in a tube TDAP phalloplasty in a 38 years old trans-man. While penis reconstruction surgery aroused an efflorescence of different operative techniques, the resulting female to male surgery sees these procedures boil down to two or three flaps. If we usually discuss before surgery about the way to lengthen the urinary tract, as the way to implant later for intercourse; the choice of the donor site remains too systematized. Surgeons commonly focus on the reconstructed site prior to the donor site. In this case, laxity in the back and reliability of direct closure make us harvest the thoracodorsal perforator flap. Dissection of perforators saves muscular function and direct closure afford an aesthetic result less visible than a graft on the forearm. The thin flap we harvest allows tube in tube phalloplasty so that phallus and urethra are being built in the same time. One case has been reported in the literature of thoracodorsal perforator flap phalloplasty with grafted urethra, but no case of tube within a tube TDAP phalloplasty. [ABSTRACT FROM AUTHOR]

Background: The superficial inferior epigastric artery (SIEA) diameter and the matching degree between the donor and the recipient arteries in terms of diameter are key factors affecting the outcome of the procedure in breast reconstructions with the SIEA flaps. A diameter of the SIEA ≥ 1.5 mm and a matching degree ≥ 1:2 (50%) of the diameters of the donor and the recipient arteries are recognized standards for the SIEA and the internal mammary artery (IMA) to achieve an end-to-end anastomosis. However, further refinements of the population characteristics and the ideal microscopic anastomosis intercostal planes are currently lacking for the criteria. Methods: In this study, based on 20 sides of hemiabdomen with computed tomography angiography (CTA) data suggesting the presence of the SIEA, we analysed the diameters of the donor and the recipient arteries as well as their matching degrees. The correlations between the parameters above and body mass index (BMI) were assessed. Based on the lower bounds of the 95% confidence intervals of the matching degrees and the two critical nodes of 50% and 67%, we theoretically evaluated the possibility of an end-to-end anastomosis of the SIEA and the IMA at different levels of BMIs and intercostal spaces, and predicted the possible intraoperative management measures for the SIEA. Results: The SIEA diameter, the thoracodorsal artery (TDA) diameter, and the diameters of the IMA at the 2nd to the 5th intercostal levels were positively correlated with the BMI (p < 0.05). A value of BMI ≥ 24 kg/m2 could indirectly reflect the application premise of the diameter of the SIEA ≥ 1.5 mm. The matching degrees of the SIEA with the TDA or the IMA at the 2nd to the 5th intercostal level were linearly and positively correlated with the BMI (p < 0.001). Based on the confidence interval analysis, we predicted different management techniques that might be needed intraoperatively for the SIEA at different BMI levels, when the SIEA and the IMA or the TDA were to be anastomosed in an end-to-end way. Conclusion: For patients with preoperative CTA data suggesting the presence of the SIEA in the second-stage breast reconstructions, when a value of BMI ≥ 24 kg/m2 is met, the SIEA and the IMA can theoretically achieve an end-to-end anastomosis at the 3rd to the 5th intercostal level, and when 24 kg/m2 ≤ BMI ≤ 25 kg/m2, due to the large difference in diameters, the SIEA and the IMA at the 2nd intercostal level might need to adopt an end-to-side anastomosis or switch to the TDA recipient site. Based on this study's findings and aesthetic effect considerations, we think that the 3rd and the 4th intercostal planes are ideal choices for the end-to-end anastomosis. As a salvage recipient option, the TDA can theoretically achieve an end-to-end anastomosis with the SIEA at a value of BMI ≥ 24 g/m2. Level of evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Diagnostic imaging modalities to evaluate the three-dimensional distribution of thoracodorsal artery perforators (TDAPs) are lacking. In this study, TDAPs were visualized and characterized using photoacoustic imaging. In this study, 34 sites in the lateral chest wall of 18 individuals were analyzed. The region extending 5 cm ventral and 5 cm dorsal to the lateral edge of the latissimus dorsi (LD) and 5–15 cm from the posterior axillary fold was scanned using photoacoustic imaging. The largest perforator closest to the edge of the LD was characterized. The location of the stem portion and the orientation of the longest cutaneous branch of the perforator were described. The relationship between the maximal depth of delineation on photoacoustic images and the depth of the deep fascia was assessed. On average, 2.6 perforators (range, 1–5 perforators) were visualized in the region of interest. The distribution of the TDAP stem portion was similar to that in previous studies. Cutaneous branches were preferentially oriented in a medial-caudal direction. The length of delineated cutaneous branches varied (range, 7–78 mm) depending on the thickness of the subcutaneous layer. Vessels under the LD were observed when the subcutaneous layer was thin. Photoacoustic imaging can successfully visualize TDAPs in three dimensions. Visualization of TDAPs varied by the thickness of the subcutaneous layer. A thin deep fascia of the LD might be a cause of deep laser penetration. [ABSTRACT FROM AUTHOR]

The latissimus dorsi is a broad muscle that originates from the inferior thoracic spinous processes, thoracolumbar fascia, iliac crest, and inferior ribs. It inserts on the inferior aspect of the intertubercular groove of the humerus through a thin tendon. The study was conducted on 10 cadavers (7 male and 3 female). These specimens were dissected and examined to study the gross anatomical characteristics of the latissimus dorsi muscle. The dimensions of the latissimus dorsi muscle and its surface area were measured in all the cadavers. The branching pattern of the thoracodorsal vessels was recorded. The pedicle length and caliper were measured using Vernier calipers. On the 20 dissected sides, the thoracodorsal artery was found to be one of the terminal branches of the subscapular artery that originates in the axillary region. In 19 (95 %) cases, the thoracodorsal artery terminated in a bifurcation, giving off a medial and a lateral branch. The average size of the elevated flap of the latissimus dorsi muscle was 18 cm' 36 cm. The average pedicle length was 9.5 cm (range: 5 cm-14 cm), and the average diameter at its origin was 2.5 mm (range: 1.5 mm-3.5 mm). The average diameter of the vena comitans was 3.3 mm. The current study focuses on the anatomical features of the latissimus dorsi muscle and its blood supply to increase the success rate of operations in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients’ (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.

Introduction: The axillary artery extends to the subclavian artery, which gives blood the axillary region. This artery is starting from the outset of the first ribAnd ends near the inferior terse major muscle, and then goes on with the name of the Brachial artery,the axillary artery variation is common and given the blood supply to the upper limb Clinically important .These variations seem to be an important finding that a rare case of anatomical presentation in an underground cavity to the right of a male body with an age of approximately 60-65 years was found in ShahidSadoughi University of Medical Sciences in Yazd, which was as followed:, external thoracic artery that is normally separated from the second part of the axillary artery;In this case, the third branch of the Thoracodorsal artery is separated. Since the axillary artery was exposed to damage, especially in cases of abdominal tenderness or removal of the axillary lymph nodes, the use of upper limb arches for coronary artery bypass surgery, Therefore, knowledge of natural anatomy and axillary artery changes will be useful for medical professionals, especially surgeons and anatomists.

Objective. This report presents a unilateral branching pattern of the axillary artery (AA) represented by an unusual common trunk division, vessel multiplications and concomitant neural variations. Case Report. In a Greek male cadaver, the right AA branched into a subscapular trunk and two accessory lateral thoracic arteries of variable origin and course. Concomitantly, a high-level interconnection between the musculocutaneous and median nerves was identified, as an accessory lateral root of the median nerve. More interestingly, a rare innervation of the upper part of the latissimus dorsi muscle by a lower subscapular nerve was also revealed. Conclusion. In-depth knowledge of the typical and variant AA branching patterns and coexisting neural variations is of paramount importance for surgeons and interventional physicians, for a safer diagnosis and for performing uneventful procedures in that area. [ABSTRACT FROM AUTHOR]

Background: Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods: We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results: The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients' (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions: The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. Methods This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix. Results Overall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as “excellent” or “good.” Conclusion Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix.

In a Greek Caucasian male cadaver, a combination of the following arterial variations were observed: an aberrant right subclavian artery originating as a last branch of the aortic arch and coursed posterior to the oesophagus, a right non-recurrent laryngeal nerve, an atypical origin of the left suprascapular artery from the axillary artery, an unusual emersion of the lateral thoracic artery from the subscapular artery and a separate origin of the left thoracodorsal artery from the axillary artery. According to the available literature the corresponding incidences of the referred variants are: 0.7% for the aberrant right subclavian artery, 1.6-3.8% for the origin of the suprascapular artery from the axillary artery, 3% for the origin of the left thoracodorsal artery from the axillary artery and 30% for the origin of the lateral thoracic artery from the subscapular artery. Such unusual coexistence of arterial variations may developmentally be explained and has important clinical significance. [ABSTRACT FROM AUTHOR]

Summary Background This study aimed to investigate the versatility of septocutaneous thoracodorsal artery perforator (TDAP-sc) flaps in various areas in the body and the running pattern of septocutaneous perforators. Methods This retrospective cohort study included 20 consecutive patients who underwent reconstruction of an oncological defect with a TDAP-sc flap from May 2014 to January 2018. Fifteen flaps were free, and the remaining five were pedicled. Surgical details and postoperative complications were investigated. Results The flap size ranged from 13 × 6.5 to 22 × 15 cm. The defect location was the upper extremity in eight patients, the head and neck in six, the lower extremity in four, and the trunk in two. The septocutaneous perforator arose from the thoracodorsal vessels proximal to the serratus anterior branch in 10 (50.0%) patients, from the thoracodorsal vessels distal to the serratus anterior branch in six (30.0%), and from the serratus anterior branch in four (20.0%). All flaps completely survived, except the one with partial necrosis. The scapula was simultaneously harvested based on the angular branch in three patients who underwent mandibular reconstruction. Conclusions The TDAP-sc flap can be a versatile option for various types of reconstruction if a dominant septocutaneous perforator is present. Prevalence of a dominant TDAP-sc is estimated at approximately 50%. However, this flap can be harvested without tedious intramuscular dissection, and the two-team approach is possible during tumor resection. The presence of a dominant septocutaneous perforator can expand indication of the TDAP flap. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze the application value of high-frequency ultrasound in the muscles, bones and the thoracodorsal artery in the subscapular region and summarize the characteristics of ultrasound. PATIENTS AND METHODS: Subscapularis muscle, bone and thoracodorsal artery of 72 healthy subjects were examined using high-frequency ultrasound, the initial segment diameter of the thoracodorsal artery and peak systolic blood flow velocity were recorded, and the ultrasonographic characteristics of subscapularis muscle, bone and thoracodorsal artery were summarized. RESULTS: The spinous processes of 7th thoracic vertebrae, 9th thoracic vertebrae and 11th thoracic vertebrae all showed strong echoes with posterior acoustic shadow. The vertebral plates of 8th thoracic vertebrae, 10th thoracic vertebrae and 11th thoracic vertebrae showed a strong linear echo on both sides of the spinous process, and the lateral side was connected with the transverse processes of 8th thoracic vertebrae, 10th thoracic vertebrae, and 11th thoracic vertebrae. The inferior scapular artery was launched from the axillary artery, along with the deep side of the inferior scapular muscle, the latissimus dorsi and teres major muscle, and then it went inferior and backward which was then divided into arteriae dorsalis scapulae and thoracodorsal artery, showing a tubular structure with no echo. Color Doppler Flow Imaging (CDFI) showed the endovascular blood flow signal of the inferior scapular artery and its branches. The internal diameter of the initial segment of the thoracodorsal artery of the male subjects was bigger than that of the female subjects, and the difference was statistically significant (p < 0.05). CONCLUSIONS: High-frequency ultrasound can provide a reliable reference for the anatomical structure and adjacent relationship of subscapular muscles, bones and thoracodorsal artery, and is worthy of being promoted as a non-invasive and reliable mean of examination. [ABSTRACT FROM AUTHOR]

The thoracodorsal artery mainly supplies the latissimus dorsi muscle. Anatomical details pertaining to the origin and distribution of thoracodorsal artery are important because the latissimus dorsi myocutaneous flap is one of the most reliable and versatile flaps used in reconstructive surgery. Atypical origin and course of the thoracodorsal artery is, therefore, a challenge for flap reconstruction surgeries. In the present case, we report multiple variations in the branching pattern of axillary artery. The thoracodorsal artery had an unusual origin from the second part of axillary artery. The trunk of thoracoacromial artery was absent. The thoracodorsal artery after its origin, descended downwards over the lateral pectoral region lying deep to pectoralis minor but superficial to teres major muscles. It terminated by supplying the latissimus dorsi muscle. Due to the presence of atypical thoracodorsal branch, the subscapular artery continued as the circumflex scapular artery. [ABSTRACT FROM AUTHOR]

Purpose: Although latissimus dorsi (LD) flaps are extensively used in a wide range of interventions, fetus studies on this subject are quite limited. This study aims to obtain detailed information about the morphometric features of LD, thoracodorsal artery (TDA) and nerve (TDN).Methods: The study was carried out on both sides of 50 formalin-fixed human fetuses (22 male/28 female) with a mean gestational age of 24.5 ± 4.7 (range 18-36) weeks, which were in the inventory of Anatomy Department of Mersin University Faculty of Medicine. Dimensions of LD, lengths and width of TDA and TDN were measured. Surface area of LD was calculated using digital image analysis software.Results: All samples had LD muscle. Neither gender nor side-significant differences were observed in relation with the numerical data of LD, TDN and TDA. Linear function of surface area was calculated as “y = − 1767.532 + 114.582 × Age (weeks)”. LD was attached directly to the posterior part of iliac crest in 59 of 100 sides meanwhile in the rest 41, it was attached by the thoracolumbar fascia. TDA gave a branch to serratus anterior in 96 cases and 2 branches in 4 cases. TDN passed superficial to TDA in 84 and deep to TDA in 16 samples. TDN had bifurcation in 93, trifurcation in 6 and tetrafurcation in 1 side.Conclusion: Data obtained from this study can be useful for estimating the sizes of LD and related neurovascular structures, especially in neonate surgeries. Linear function of LD surface area can be helpful to design the flap dimensions in newborn surgeries. A throughout knowledge about the branching pattern of TDN and its location-wise relation with TDA should be kept in mind to prevent possible complications during harvesting LD flaps and TDN grafts. [ABSTRACT FROM AUTHOR]

Background: Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. Methods: This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix. Results: Overall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as "excellent" or "good." Conclusion: Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix. [ABSTRACT FROM AUTHOR]

Anatomic variations of axillary artery branches are commonly encountered during radiological investigation and surgical operations. Their existence can confuse interpretation of radiological results and lead to undesired complications during surgery. In this report authors describe a rare case of a subscapular arterial trunk that gave origin to thoracodorsal, circumflex scapular, posterior humeral circumflex, and lateral thoracic artery. Such a variation might cause undesired sequelae during trauma management and a variety of common flap harvesting operations including latissimus dorsi, scapular and parascapular flaps. Furthermore it presents embryological interest as it gives insight to embryologic development of axillary area. [ABSTRACT FROM AUTHOR]

This article deals with a clinical case of a tube in a tube TDAP phalloplasty in a 38 years old trans-man. While penis reconstruction surgery aroused an efflorescence of different operative techniques, the resulting female to male surgery sees these procedures boil down to two or three flaps. If we usually discuss before surgery about the way to lengthen the urinary tract, as the way to implant later for intercourse; the choice of the donor site remains too systematized. Surgeons commonly focus on the reconstructed site prior to the donor site. In this case, laxity in the back and reliability of direct closure make us harvest the thoracodorsal perforator flap. Dissection of perforators saves muscular function and direct closure afford an aesthetic result less visible than a graft on the forearm. The thin flap we harvest allows tube in tube phalloplasty so that phallus and urethra are being built in the same time. One case has been reported in the literature of thoracodorsal perforator flap phalloplasty with grafted urethra, but no case of tube within a tube TDAP phalloplasty., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)