Design of mini latissimus dorsi flap based on thoracodorsal vascular patterns.
Association of Breast Surgery ePoster Library. Kelada M. 05/15/17; 166230; P004
Melad Kelada
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Abstract
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Introduction: latissimus dorsi (LD) flap has long been used for reconstructive purposes especially in oncoplastic breast surgery. Using large part of the muscle as a myocutaneous flap leads to a residual functional loss. Recently, muscle sparing mini LD flap can be used with no functional sequelae. However, the design of such flap presents a challenge.
Materials and methods: Twenty adult cadavers were dissected on both sides to identify the different vascular patterns of the thoracodorsal (TD) pedicle. The vessels were counted and the following measurements were taken using Vernier caliper: diameter, length and distance from inferior angle of scapula. Data was collected and entered into the personal computer. Statistical analysis was done using Statistical Package for Social Sciences (SPSS/version 20) software.
Results: Five vascular patterns of TD pedicle were found. Type 1: a long vertically descending pedicle giving 3-4 transverse medial branches to LD in 40%. Type 2: a short pedicle terminating into 1-2 serratus anterior collaterals and 1-2 transverse lateral branches to LD in 10%. Type 3: a long vertically descending pedicle giving 2-3 small lateral branches to upper part of LD and terminating into medial and lateral branches in the lower part of LD in 10%. Type 4: a short pedicle that gives 4-5 terminal branches to LD, one of them is a long vertically descending branch to lower part of LD in 20%. Type 5: a short pedicle that terminates into a transverse medial and a long vertical branch to LD in 20%.
Conclusion: the classically described pattern of TD pedicle (type5) was only found in 20% of cases while the most commonly found pattern was type 1. This means that the pattern of TD branching is unpredictable and a preoperative ultrasound is essential to define the existing pattern and plan the best mini LD flap design for each patient. In types 1 and 5, the flap can be designed using the transverse medial branch or branches. In type 2, one of the lateral transverse branches can be used. In types 3,4 and 5, the long descending vertical branch can be used. It has a sizeable diameter (1.80.23mm), length (12.31.64cm) and can be located 6.50.96cm below the inferior angle of scapula.
Key words: mini flap- TD pedicle- breast reconstruction.
Materials and methods: Twenty adult cadavers were dissected on both sides to identify the different vascular patterns of the thoracodorsal (TD) pedicle. The vessels were counted and the following measurements were taken using Vernier caliper: diameter, length and distance from inferior angle of scapula. Data was collected and entered into the personal computer. Statistical analysis was done using Statistical Package for Social Sciences (SPSS/version 20) software.
Results: Five vascular patterns of TD pedicle were found. Type 1: a long vertically descending pedicle giving 3-4 transverse medial branches to LD in 40%. Type 2: a short pedicle terminating into 1-2 serratus anterior collaterals and 1-2 transverse lateral branches to LD in 10%. Type 3: a long vertically descending pedicle giving 2-3 small lateral branches to upper part of LD and terminating into medial and lateral branches in the lower part of LD in 10%. Type 4: a short pedicle that gives 4-5 terminal branches to LD, one of them is a long vertically descending branch to lower part of LD in 20%. Type 5: a short pedicle that terminates into a transverse medial and a long vertical branch to LD in 20%.
Conclusion: the classically described pattern of TD pedicle (type5) was only found in 20% of cases while the most commonly found pattern was type 1. This means that the pattern of TD branching is unpredictable and a preoperative ultrasound is essential to define the existing pattern and plan the best mini LD flap design for each patient. In types 1 and 5, the flap can be designed using the transverse medial branch or branches. In type 2, one of the lateral transverse branches can be used. In types 3,4 and 5, the long descending vertical branch can be used. It has a sizeable diameter (1.80.23mm), length (12.31.64cm) and can be located 6.50.96cm below the inferior angle of scapula.
Key words: mini flap- TD pedicle- breast reconstruction.
Introduction: latissimus dorsi (LD) flap has long been used for reconstructive purposes especially in oncoplastic breast surgery. Using large part of the muscle as a myocutaneous flap leads to a residual functional loss. Recently, muscle sparing mini LD flap can be used with no functional sequelae. However, the design of such flap presents a challenge.
Materials and methods: Twenty adult cadavers were dissected on both sides to identify the different vascular patterns of the thoracodorsal (TD) pedicle. The vessels were counted and the following measurements were taken using Vernier caliper: diameter, length and distance from inferior angle of scapula. Data was collected and entered into the personal computer. Statistical analysis was done using Statistical Package for Social Sciences (SPSS/version 20) software.
Results: Five vascular patterns of TD pedicle were found. Type 1: a long vertically descending pedicle giving 3-4 transverse medial branches to LD in 40%. Type 2: a short pedicle terminating into 1-2 serratus anterior collaterals and 1-2 transverse lateral branches to LD in 10%. Type 3: a long vertically descending pedicle giving 2-3 small lateral branches to upper part of LD and terminating into medial and lateral branches in the lower part of LD in 10%. Type 4: a short pedicle that gives 4-5 terminal branches to LD, one of them is a long vertically descending branch to lower part of LD in 20%. Type 5: a short pedicle that terminates into a transverse medial and a long vertical branch to LD in 20%.
Conclusion: the classically described pattern of TD pedicle (type5) was only found in 20% of cases while the most commonly found pattern was type 1. This means that the pattern of TD branching is unpredictable and a preoperative ultrasound is essential to define the existing pattern and plan the best mini LD flap design for each patient. In types 1 and 5, the flap can be designed using the transverse medial branch or branches. In type 2, one of the lateral transverse branches can be used. In types 3,4 and 5, the long descending vertical branch can be used. It has a sizeable diameter (1.80.23mm), length (12.31.64cm) and can be located 6.50.96cm below the inferior angle of scapula.
Key words: mini flap- TD pedicle- breast reconstruction.
Materials and methods: Twenty adult cadavers were dissected on both sides to identify the different vascular patterns of the thoracodorsal (TD) pedicle. The vessels were counted and the following measurements were taken using Vernier caliper: diameter, length and distance from inferior angle of scapula. Data was collected and entered into the personal computer. Statistical analysis was done using Statistical Package for Social Sciences (SPSS/version 20) software.
Results: Five vascular patterns of TD pedicle were found. Type 1: a long vertically descending pedicle giving 3-4 transverse medial branches to LD in 40%. Type 2: a short pedicle terminating into 1-2 serratus anterior collaterals and 1-2 transverse lateral branches to LD in 10%. Type 3: a long vertically descending pedicle giving 2-3 small lateral branches to upper part of LD and terminating into medial and lateral branches in the lower part of LD in 10%. Type 4: a short pedicle that gives 4-5 terminal branches to LD, one of them is a long vertically descending branch to lower part of LD in 20%. Type 5: a short pedicle that terminates into a transverse medial and a long vertical branch to LD in 20%.
Conclusion: the classically described pattern of TD pedicle (type5) was only found in 20% of cases while the most commonly found pattern was type 1. This means that the pattern of TD branching is unpredictable and a preoperative ultrasound is essential to define the existing pattern and plan the best mini LD flap design for each patient. In types 1 and 5, the flap can be designed using the transverse medial branch or branches. In type 2, one of the lateral transverse branches can be used. In types 3,4 and 5, the long descending vertical branch can be used. It has a sizeable diameter (1.80.23mm), length (12.31.64cm) and can be located 6.50.96cm below the inferior angle of scapula.
Key words: mini flap- TD pedicle- breast reconstruction.
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