Perforator Flaps Based on the Terminal Perforators of the Pectoral Branch of Thoracoacromial Vessels Axis: A Viable Option in the Head and Neck Reconstructions

The thoracoacromial trunk: a detailed analysis

PURPOSE

The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps.

METHODS

A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed.

RESULTS

A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made.

CONCLUSION

In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.