Anatomical View of Thoracodorsal Artery Variants Using Computed Tomography Angiography

Abstract

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.

The Arterial System of the Fasciocutaneous Deltoid Flap Pedicle on 320-Detector Row Computed Tomography and Clinical Application in the Foot and Hand

“…Some authors have used a computed tomography angiography 64-slice CT scanner (CTA-64) or 320-detector row computed tomography angiography (CTA-320) to investigate the “arterial tree” of flaps in the lower limbs, abdomen, or toe, obtaining clear images. 19 20 21 22 23 24 According to these researchers, the anatomical results obtained from MDCT and the surgical findings are remarkably consistent. 21 22 Given the limitations of the traditional dissection method and the clear advantages of the MDCT method in vessel studies, we sought anatomical studies and reports on the deltoid flap vascular pedicle that used CTA-320 for imaging.…”

“…In 2009, Sharma et al 18 described a variant case in which the axillary artery was divided into the brachial artery, the common trunk of the anterior and posterior circumflex branches, and the deep brachial artery. In 2023, Cho et al 19 reported variant cases of the origin of the PCHA. The PCHA originated from the distal part of the axillary artery following the classical description in 74% of cases, while it was observed from the subscapular artery in the remaining cases.…”

Free Vertical Latissimus Dorsi Flap for Tongue Reconstruction After Total Glossectomy

“…When the volume of the flap decreases and the size of the canal increases, there is an increased risk of aspiration and speech difficulties, which significantly impairs communication with the likelihood of problems arising. Therefore, in this study, we have proposed a design for tongue reconstruction using the LD flap, which is one of the flaps that can provide the largest volume in the human body and is easily accessible for reconstruction surgeons with fewer pedicle variants (18). The design is Figure 6.…”