Anatomical study and clinical application of thoracoacromial artery perforator flap

Abstract

Objective:To study the anatomical characteristics of thoracoacromial artery perforator flap（TAAP）, and to explore the advantages and disadvantages of TAAP in head and neck reconstruction. Methods: Four fresh cadavers （8 hemichests） were collected for anatomical observation, the blood supply of chest skin was observed through autopsy, the presence, number, location, caliber, and landmark on the chest surface of all thoracoacromial artery perforators per hemichest were recorded, including the distance of each from the midpoint of the clavicle. The diameters of the thoracoacromial artery and perforating vessels were measured with vernier calipers （accuracy 0.05 mm）, the pedicle length and thickness were measured with a cm scale （accuracy: 1 mm） after the flap was obtained, and the retained photos were recorded. Results:No perforating branch （12.5%） was found on one side of the 8 hemichests, two perforating branches （12.5%） were found on one hemichest, and one perforating branches （75.0%） were found on the rest of the hemichests. The perforating point was about between the clavicular head of pectoralis major （clavicular part） and the sternocostal head （sternocostal part）. The vessels at the beginning of perforation were generally bulky, with an average diameter of 2.25 mm, however, the vessel diameter was significantly reduced after the perforation of the flap. The pedicle length of thoracoacromial artery perforator flap ranged from 5.43 cm to 9.03 cm, with an average length of 7.14 cm. The pedicle length from the exit point of perforator muscle gap to the flap was 2.32-4.63 cm, with an average length of 3.28 cm. The distance between the exit point of perforator muscle space and the lower edge of the midpoint of the clavicle was 3.31-4.52 cm, with an average distance of 3.77 cm. Conclusion:The thoracoacromial artery perforator flap has some advantages such as similar color as head, neck and maxillofacial region, stable blood supply, relatively consistent vascular pedicle length and caliber size, relatively larger flap, less damage to pectoralis major muscle, and protection of chest shape, thoracic movement and shoulder joint movement function. Although the clinical application of this flap is limited by the uncertainty of perforating vessels, postoperative asymmetry of the nipple and residual chest scar, it still has a broad application prospect in head and neck reconstruction.