Lateral Thoracic Artery Research Articles

Coil embolization of a fistula from the right inferior phrenic artery to the right pulmonary artery with involvement of further arteries: A rare case report

A 51-year-old female patient presenting dyspnea for more than a year with no previous lung infections or surgery. Initially, a diagnostic computed tomography was made, showing a rare arterio-arterial malformation between the right inferior phrenic and right pulmonary artery leading into a vascular bundle in the middle lung lobe. Due to the patients ? dyspnea and massive extent of malformation, the indication for transcatheter arterial embolization was made. The first transcatheter arterial embolization procedure involved the inferior phrenic and a selective branch of the internal thoracic artery. Interventional angiography as well as computed tomography revealed further extend of the malformation showing a connection of right lateral thoracic, hepatic, and inferior epigastric artery to the fistula. After one month, a second transcatheter arterial embolization of these arteries as well as a second approach of the proximal internal thoracic artery was performed. In the follow-up the patient described a substantial improvement of her dyspnea and showed no signs of infections. A phrenic artery to pulmonary artery fistula is an extremely rare case occurring congenital or acquired. Patients may be asymptomatic or present, among others, dyspnea, hemoptysis, pulmonary infections and congestive heart failure. Symptomatic patients require treatment using transcatheter arterial embolization or surgical resection. The patient had dyspnea and a substantial extent of malformation with possibly complicated clinical course. The recommended less invasive treatment using transcatheter arterial embolization was successfully performed. In conclusion, our patient represented a rare congenital case of systemic and pulmonary artery communication, which we were able to treat sufficiently with coil embolization.

Application of a modified lateral thoracic artery perforator flap in partial breast defects.

Breast cancer has become the most frequently diagnosed cancer in the world. Detection at an early stage, frequently allows women to benefit from breast conserving surgery. However, some patients are not satisfied with the breast shape after breast-conserving surgery, and autologous tissue flaps are needed to fill the defect in the resection area. The modified lateral thoracic artery perforator (LTAP) flap isn't one of the commonly used flaps in breast surgery and has the advantages of a reliable blood supply, simple operation and few postoperative complications. In this study, we aimed to evaluate the feasibility and effectiveness of a modified LTAP flap for repairing partial breast defects after breast-conserving surgery. In this study, we retrospectively analyzed the clinical data of 126 patients treated with LTAP flaps to repair local breast defects at Affiliated Hospital of Guangdong Medical University between January 2020 and June 2021. Data were collected on the demographic characteristics of these patients, tumor size and location, type of axillary lymph node surgery, availability of adjuvant chemotherapy and radiotherapy, and postoperative complications. The median weight of the tumor specimen was 185 g (range, 170-320 g), and this glandular tissue accounted for 30% to 40% of the total breast volume. The average flap size was 10.5 cm ×2.5 cm (length range, 8-15 cm, width range: 2-4 cm). The minimum follow-up time was 6 months, with an average of 10 months (range, 6-22 months). The mean operative time was 130 minutes (range: 90-180 minutes), and the mean hospital stay was 3 days (range, 2-5 days). All modified LTAP flaps survived completely without donor site complications. None of the patients required revision surgery on the postoperative breast. The modified LTAP flap is a reliable method for repairing partial breast defects after breast-conserving surgery. It has the advantages of a simple operation, a reliable blood supply, fewer postoperative complications, and a high flap survival rate. It is especially suitable for Asian women with small breast volumes and can achieve good breast contouring effects.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

909: MULTIPLE ARTERIAL COLLATERALS TO AN ASPERGILLOMA CAUSING RECURRENT HEMOPTYSIS

Introduction: Aspergillus is a fungus that is ubiquitous in the environment and causes various clinical syndromes depending on host characteristics. The spectrum of disease affects 3 million people worldwide and ranges from an asymptomatic fungal ball to lung destruction. We present a patient with a history of tuberculosis and pulmonary aspergilloma which parasitized multiple arterial sources including the bronchial artery, internal mammary artery, and several subclavian artery branches with venous fistulization. Description: A 79-year-old man presented with 6 months of daily hemoptysis. His past medical history was significant for diabetes mellitus, severe centrilobular emphysema, mycobacterium avium complex infection, and previously treated tuberculosis. A computed tomography scan of the chest demonstrated a left upper lobe (LUL) mass with cavitation. He underwent flexible bronchoscopy with bronchoalveolar lavage and endobronchial biopsy of the LUL. The fungal culture grew Aspergillus fumigatus which correlated with the biopsy which revealed a conglomerate of septate hyphae consistent with an aspergilloma. He was referred for bronchial artery angiogram with embolization. During the procedure multiple arterial feeders to the aspergilloma were identified. This included the left bronchial artery, left internal mammary artery, left superior thoracic artery, left thoraco-acromial artery and left lateral thoracic artery. Each of these arteries supplying the aspergilloma demonstrated the added complexity of venous fistulization. Due to the presence of venous fistulas, embolization was performed using n-butyl cyanoacrylate with lipiodol. Considering the patient’s clinical stability, length of procedure and radiation time and contrast administered, as well as the absence of active bleeding during the procedure, the left internal mammary artery and left thoraco-acromial artery were not embolized with the intent of a follow-up procedure. Discussion: Chronic pulmonary aspergillosis can cause life-threatening hemoptysis when arterial feeders develop to supply an aspergilloma. First line treatment options include bronchial arterial embolization. This case highlights the unusual presentation of an aspergilloma that both parasitized numerous systemic arteries while forming venous fistulas, a rare phenomenon.

The Ultrasound Evolution of Lateral Thoracic Perforator Flaps Design and Harvest for Partial and Total Breast Reconstruction.

The lateral thoracic area is a known source for perforator flaps for partial breast reconstruction. In this paper, we report our experience in designing and harvesting lateral thoracic perforator flaps for partial and total breast reconstruction with the introduction of the "propuller" concept. Between September 2013 and August 2021, 95 flaps were performed for immediate, partial and total breast reconstruction. On a total of 95 flaps, 30 (19 thoracodorsal artery perforator(TDAP) flaps, 10 lateral intercostal artery perforator(LICAP) flaps and 1 lateral thoracic artery perforator(LTAP) flap) were harvested in the traditional fashion (control group) and 65 (57 LICAP, 2 LTAP and 6 TDAP flaps) according to the propeller concept (study group). All cases were preoperatively planned with Color-Coded Duplex Ultrasound. No flap losses were experienced in both groups. The mean operative time was 156 minutes (range 118-234) for the control group and 75 minutes (range 53-125) for the study group (p<0.0001). A significantly higher number of LICAP flaps were chosen in the study group compared to control group. None of the patients had donor site complications. Patients' and Surgeons' satisfaction was high to very high. The ultrasound preoperative planning led to the development of an easier and safer method of local perforator flap harvesting, that we named as propuller design. Its novelty lies in that perforator intraoperative selection and fully skeletonization are not needed and a more efficient flap movement (propeller plus advancement) which transfers more tissue into the new breast can be achieved safely, faster and easier.

Prevalence of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization.

To identify the prevalence of non-bronchial systemic culprit arteries and their relationship to bleeding lobes in patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization (BAE). Data of 83 consecutive patients with bronchiectasis and chronic pulmonary infection (non-tuberculous mycobacteriosis, aspergillosis, and tuberculosis) who underwent de novo BAE between January 2019 and December 2020 were retrospectively reviewed. The prevalence of culprit arteries was investigated. Fifty-five patients (66%) had 172 non-bronchial systemic culprit arteries. The bleeding lobes were the right upper, right middle, right lower, left upper, and left lower lobes in 14 (17%), 20 (24%), 7 (8%), 31 (37%), and 11 (13%) patients, respectively. The internal thoracic (49%; n = 41), intercostal (28%; n = 23), and inferior phrenic (28%; n = 23) arteries were the top three non-bronchial systemic culprit arteries, which were involved in all five types of bleeding lobes. The costocervical trunk and thoracoacromial and lateral thoracic arteries were predominant in patients with upper lobe bleeding. Ligament arteries were predominant in patients with left lower lobe bleeding. These findings will better ensure the identification of non-bronchial systemic culprit arteries in patients with hemoptysis with bronchiectasis and chronic pulmonary infection. All systemic arteries, especially those which are adjacent to the lung lesions, should be evaluated carefully using MDCT; the internal thoracic, intercostal, and inferior phrenic arteries should be proactively assessed using angiography. • Non-bronchial systemic culprit arteries were identified in 66% of patients with hemoptysis with bronchiectasis and chronic pulmonary infection who underwent de novo bronchial artery embolization. • The internal thoracic (49%), intercostal (28%), and inferior phrenic (28%) arteries were the top three arteries, which were involved in all five types of bleeding lobes. • The costocervical trunk and thoracoacromial and lateral thoracic arteries were prominent in patients with upper lobe bleeding, and the ligament artery was prominent in patients with left lower lobe bleeding.

Vascular anatomy of the breast and its implications in the breast-sharing reconstruction technique

The most frequently described breast-sharing procedure consists in a pedicled technique where the transferred lower breast pole is based on the lower perforators of the internal mammary (IM) artery. The current article investigates the vascular supply of the breast and its surgical implications in breast-sharing reconstruction. Contrast-enhanced magnetic resonance images of 55 patients (110 breasts) were retrospectively examined. A total of 473 branches of the IM, lateral thoracic (LT) and anterior intercostal (AI) arteries with a diameter greater than 0.5mm were traced throughout their course in the breast. Distinct connections between the vessels were equally recorded. Although any vessel could vascularise any quadrant in the individual patient, blood supply to the lower quadrants came fundamentally from the AI arteries (76.2% of all the perforators). Lower IM branches (4th-5th) were seen to reach both lower quadrants in only 6.4% of the breasts, whereas LT branches did in 15.5%. In 86.4% of the breasts, at least a distinct AI perforator was seen to perfuse both lower quadrants. Well-defined connections between the IM and the LT arteries were observed in 41.8% of the breasts, always at or above the nipple-areola level. Other connections were far less common. Our study strongly indicates that the breast-sharing technique based on 4th-5th contralateral branches of the IM or LT arteries is unreliable in most patients. Given the unpredictable vascularization pattern in the lower breast pole, a preoperative imaging study is mandatory when the use of the contralateral breast is considered. Due to its accuracy, availability, and anatomical reliability, contrast-enhanced magnetic resonance is the best technique in the preoperative evaluation of the breast-sharing reconstruction.

Modifications of the LICAP/LTAP Flap Technique in Partial Breast Reconstruction for Difficult Tumor Locations.

The authors propose modifications of the lateral thoracic artery perforator/lateral intercostal artery perforator flap partial breast reconstruction that can help achieve improved aesthetic results, especially for centrally and medially located tumors. Lumpectomy is performed using the retromammary approach through lateral contour access without skin mobilization from parenchyma. This minimizes trauma and scarring of parenchyma and skin in the lateral part of the breast. In case of central or medial location of the tumor, the authors propose moving the flap into the tumor bed through a cut ("window") in the musculus pectoralis major. This helps stabilize the flap in an optimal position and redistribute the tissue without compression on the flap pedicle or bulge in the lateral sector of the gland. The authors have used this modification in 18 patients. The average tumor size was 2.8 cm (range, 1.2 to 5.4 cm) and the average weight of the specimens was 46.6 g (range, 14 to 110 g). Two patients had a tumor in the upper-inner quadrant close to the breast meridian, two in a central-lateral tumor location, and 14 in the upper-outer quadrant. Early complications occurred in four cases: two seromas of the wound, one partial flap necrosis with revision and resection of the flap, and one cellulite in the axillary region after axillary dissection because of long-standing lymphorrhea and drainage. The proposed modification of the lateral thoracic artery perforator/lateral intercostal artery perforator flap technique in partial breast reconstruction can lead to better aesthetic results and improved safety.

Treatment of chest wall osteoradionecrosis with a contralateral breast Y-V flap: a case report

Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Surgical technique for preservation of extrathoracic collateral networks in thoracoabdominal aortic surgery.

Salvaging the Lateral Thoracic Artery in PMMC Flap is it Worth an Effort?

Salvaging the Lateral Thoracic Artery in PMMC Flap is it Worth an Effort?

Long-term outcomes of oncoplastic breast resection with local perforator flaps

Background. Oncoplastic breast resections with perforator flaps are relatively common now; however, many studies demonstrate contradictory results, especially in terms of long-term outcomes.Objective: to assess short-term and long-term outcomes of oncoplastic breast resection with defect repair using perforator flaps.Materials and methods. This study included 62 breast cancer patients who underwent oncoplastic breast resection with defect repair using local perforator flaps, including lateral intercostal artery perforator (LICAP) flaps (40.3 %), lateral thoracic artery perforator (LTAP) (19.4 %), anterior intercostal artery perforator (AICAP) (27.4 %), and medial intercostal artery perforator (MICAP) (12.9 %) flaps. The assessment of oncological, functional, and aesthetic outcomes was performed in patients who were followed-up for at least a year (n = 57). Mean follow-up time was 26.5 months (range: 14–38 months).Results. The following complications were registered among the patients studied: seroma in the area of excised primary tumor (8.1 %), insufficient blood supply of the flap that caused focal lipofibrosis/liponecrosis (3.2 %), positive resection margin (3.2 %), low position of the submammary fold (11.3 %), locoregional recurrence (0 %), generalized process (3.5 %). All women evaluated their functional and aesthetic result as good or excellent. According to BCCT.core 3.0, 91.3 % of patients achieved good and excellent results.

Clinical application of expanded internal mammary artery perforator flap combined with vascular supercharge in reconstruction of faciocervical scar

Objective: To summarize the clinical experience of expanded internal mammary artery perforator (IMAP) flap combined with vascular supercharge in reconstruction of faciocervical scar. Methods: The retrospective observational study was conducted. From September 2012 to May 2021, 23 patients with postburn or posttraumatic faciocervical scars who met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 18 males and 5 females, aged from 11 to 58 years, all of whom were reconstructed with expanded IMAP flaps. At the first stage, one or two skin and soft tissue expander (s) with appropriate rated capacity were implanted in the anterior chest area according to the location and size of the scars. The IMAP, thoracic branch of supraclavicular artery, and lateral thoracic artery were preserved during the operation. The skin and soft tissue expanders were inflated with normal saline after the operation. The flaps were transferred during the second stage. The dominant IMAP was determined preoperatively using color Doppler ultrasound (CDU) blood flow detector. The faciocervical scars were removed, forming wounds with areas of 9 cm×7 cm-28 cm×12 cm, and the perforators of superficial temporal artery and vein or facial artery and vein were preserved during the operation. The flaps were designed according to the area and size of the wounds after scar resection with the dominant IMAP as the pedicle. Single-pedicle IMAP flaps were used to repair small and medium-sized wounds. For larger defects, the blood perfusion areas of vessels in the anterior chest were evaluated by indocyanine green angiography (ICGA). In situations where the IMAP was insufficient to nourish the entire flap, double-pedicle flaps were designed by using the thoracic branch of supraclavicular artery or lateral thoracic artery for supercharging. Pedicled or free flap transfer was selected according to the distance between the donor areas and recipient areas. After transplantation of flaps, ICGA was conducted again to evaluate blood perfusion of the flaps. The donor sites of flaps were all closed by suturing directly. Statistics were recorded, including the number, rated capacity, normal saline injection volume, and expansion period of skin and soft tissue expanders, the location of the dominant IMAP, the total number of the flaps used, the number of flaps with different types of vascular pedicles, the flap area, the flap survival after the second stage surgery, the occurrence of common complications in the donor and recipient areas, and the condition of follow-up. Results: Totally 25 skin and soft tissue expanders were used in this group of patients, with rated capacity of 200-500 mL, normal saline injection volume of 855-2 055 mL, and expansion period of 4-16 months. The dominant IMAP was detected in the second intercostal space (20 sides) or the third intercostal space (5 sides) before surgery. A total of 25 expanded flaps were excised, including 2 pedicled IMAP flaps, 11 free IMAP flaps, 4 pedicled thoracic branch of supraclavicular artery+free IMAP flaps, and 8 free IMAP+lateral thoracic artery flaps, with flap areas of 10 cm×8 cm-30 cm×14 cm. After the second stage surgery, tip necrosis of flaps in three patients occurred, which healed after routine dressing changes; one patient developed arterial embolism and local torsion on the vascular pedicle at the anastomosis of IMAP and facial artery, and the blood supply recovered after thrombectomy and vascular re-anastomosis. Fourteen patients underwent flap thinning surgery in 1 month to 6 months after the second stage surgery. The follow-up for 4 months to 9 years showed that all patients had improved appearances of flaps and functions of face and neck and linear scar in the donor sites of flaps, and one female patient had obvious nipple displacement and bilateral breast asymmetry. Conclusions: The expanded IMAP flap is matched in color and texture with that of the face and neck, and its incision causes little damage to the chest donor sites. When combined with vascular supercharge, a double-pedicle flap can be designed flexibly to further enhance the blood supply and expand the flap incision area, which is a good choice for reconstruction of large faciocervical scar.

Chest-Wall Collateral Embolization to Reduce Surgical Blood Loss in Peripheral Aspergillomas.

The objective of this study was to present the procedural details and digital subtraction angiography (DSA) findings of perioperative chest-wall collateral embolization (PCCE) and compare intraoperative blood loss in patients of pulmonary aspergilloma (PA) undergoing lung resection with and without PCCE. Since November 2017, we have performed PCCE in 17 patients (14 males, three females, age 34.41 ± 12.85 years) before surgery for PA (embolization group). Retrospective evaluation of these patients was done, DSA findings were noted, and perioperative parameters (surgical approach, extent of resection, operative time, blood loss, blood transfusion, morbidity grade, and length of post-operative stay) were compared with a comparative cohort of 24 patients of PA (21 males, three females, mean age 36.13 ± 12.58 years) who underwent thoracic surgery without PCCE (May 2013-November 2017) (control group) using the Mann-Whitney U test. A total of 55 arteries were embolized in 17 patients (mean 3.23 arteries per patient). Technical success could be achieved in all patients without any procedure-related complications. The most common arteries embolized were posterior intercostal arteries (29) followed by costocervical trunk (10), superior thoracic (8), lateral thoracic (5), and internal thoracic arteries (3). The mean blood loss was significantly lower in the embolization group compared with the control group (676.47 vs. 1,264.58 mL, p = 0.015). Within the embolization group, patients who underwent video-assisted thoracoscopic surgery had even lower blood loss compared with open surgery cases (466 vs. 887.50 mL, p-value = 0.046). PCCE is a simple and safe procedure, useful in reducing intra-operative blood loss in patients undergoing surgery for peripherally located PA.

Aberrant arrangement of the musculocutaneous and median nerves in the thoracic limbs of a mixed-breed dog cadaver.

In the left thoracic limb of a male cadaver (adult mixed-breed dog), the median nerve (MN) after departing from the common median/ulnar nerve (UN) trunk received two branches. One from the lateral thoracic nerve (LTN) and the other from the musculocutaneous nerve (MCN). These both passed cranial to the axillary artery at the level of the lateral thoracic artery and joined the median nerve. Thus, in the proximal brachium, the axillary artery was cradled by this union, similar to the ansa axillaris of large animals and similar formations reported in human and non-human primates. In the distal brachium, the communicating branch ran unusually from the MN to the MCN on the left, and in both directions on the right. Awareness of such anatomical variations of the terminal branches of the brachial plexus (BP) in addition to the embryonic and evolutionary aspects can be useful in explaining neuroarterial signs with unknown origin, as those reported in human medicine.

MORPHOLOGICAL VARIATION IN BRANCHING COURSE AND DISTRIBUTION OF AXILLARY ARTERY IN NORTH INDIAN POPULATION

Anomalous arterial pattern are having significant importance for anatomist, vascular reconstruction surgeons and radiologists. The present study was conducted on 22 formalin fixed cadavers. Out of which 4 cadavers showed variation in the course and branching pattern of superior thoracic artery. In 2 male cadavers, superior thoracic artery showed unusual course and other 2 cadavers showed variations in the branching pattern of lateral thoracic and subscapular arteries. Knowledge of these arterial patterns is useful in determining pathology of arteries, their proper surgical procedures and proper diagnostic interpretation.

Lateral chest wall perforator flaps in partial breast reconstruction

BackgroundBreast conserving surgery (BCS) has been a standard procedure for the treatment of breast cancer instead of mastectomy whenever possible. Lateral chest wall perforator flaps are one of the volume replacement techniques that participate in increasing the rate of BCS especially in small- to moderate-sized breasts with good cosmetic outcome. In this study, we tried to evaluate the outcome of those flaps as an oncoplastic procedure instead of the conventional flaps.MethodsThis study included 26 patients who underwent partial mastectomy with immediate reconstruction using lateral chest wall perforator flaps in the period from October 2019 to November 2020. The operative time, techniques, and complications were recorded. The cosmetic outcome was assessed 3 months post-radiation therapy through a questionnaire and photographic assessment.ResultsLateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP) and combined flaps were performed in 24, 1, and 1 patients, respectively. The mean operative time was 129.6 ± 13.2 min. The flap length ranged from 10 to 20 cm and its width from 5 to 9 cm. Overall patients’ satisfaction was observed to be 88.5% as either excellent or good and the photographic assessment was 96.2% as either excellent or good.ConclusionsLateral chest wall perforator flaps are reliable and safe option for partial breast reconstruction with an acceptable aesthetic outcome. In the era of oncoplastic breast surgery, they deserve to gain attention especially with the advantages of some modifications added to the classic technique.

Variable Origin of Axillary Artery Branches in Indian Male Cadaver- A Case Report

In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon symptoms and signs. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the anatomy department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches.

Unusual Multiple Arterial Variations of the Upper Limb

During routine dissection of a 64-year-old male cadaver, multiple variations were observed in the arteries of the upper extremities. The first part of the axillary artery did not give any branches. The second part, after giving superior thoracic and thoracoacromial arteries divided into deep and superficial brachial arteries. Superficial brachial artery gave lateral thoracic artery and continued into the arm. After giving anterior circumflex humeral artery, the deep brachial artery trifurcated into the subscapular artery, posterior circumflex humeral artery, and profunda brachii artery. Understanding upper limb arterial variations are important for performing safer clinical procedures.

Exploration of chest wall perforator vascular anatomy on standard breast MRI: A potential aid to chest wall perforator flap planning

Local chest wall perforator flaps (CWPFs) are a volume replacement technique permitting breast-conserving surgery in patients who otherwise may require a mastectomy. These flaps are based on one or more perforating arteries arising from the lateral chest wall that travel through the soft tissue and into the sub-dermal plexus to perfuse the flap. Examples include the lateral intercostal and lateral thoracic artery perforators (LICAP and LTAP, respectively). Cross-sectional imaging of perforating vessels is not routinely performed, and vessels are mapped pre- and peri-operatively using a hand-held acoustic doppler device. As many breast cancer patients undergo pre-operative MRI scanning for oncological purposes, we investigated the role of MRI in mapping the vascular anatomy to aid with the surgical planning of CWPFs. We collated data retrospectively on a cohort of breast cancer patients who underwent breast MRI as part of routine pre-operative imaging. Axial 3D high-resolution dynamic contrast-enhanced MRI sequences with multiplanar reconstructions were analysed by a consultant radiologist. The presence and calibre of lateral chest wall perforator vessels were assessed. Fifty patients were suitable for inclusion. A consistent pattern of lateral chest wall vasculature was observed. Forty-eight patients (96%) demonstrated a bilateral lateral thoracic artery (LTA) descending inferiorly along the chest wall with two-thirds of these communicating with perforating intercostal vessels. True independent LICAP vessels were identified in six patients. From our observations, lateral CWPFs are dependent on an intricate intercommunication between intercostal vessels and the LTA which in turn supply perforators to the lateral chest wall donor site.