We discovered a variation in the branching pattern of the right axillary artery during routine dissection of an approximately 60-year-old male cadaver for postgraduate and undergraduate medical students at the postgraduate institute of ayurveda dr sarvepalli radhakrishnan rajasthan ayurved university Jodhpur. The second part of the axillary artery gave rise to thoracoacromial artery and a shared trunk that split into the subscapular and lateral thoracic arteries. The anterior and posterior circumflex humeral arteries were formed by the third part of the right axillary artery. Variations in the branching pattern of the axillary artery are essential for cardiovascular surgeons doing interventional or diagnostic operations.

Clinical outcomes and aesthetic satisfaction of the lateral thoracic artery perforator (LTAP) flap in immediate oncoplastic breast reconstruction following breast-conserving surgery.

Lymphedema of the arm and reduced shoulder mobility are common complications of breast cancer treatment. We aim to establish whether the radiation dose received by the area of the axillary lateral thoracic artery vessel juncture (ALTJ) and the shoulder joint-affect the development of the mentioned side effects. In this retrospective study, 298 patients with early breast cancer treated surgically and with adjuvant radiation therapy, were included. Clinical data from the prospective database were used. Physiotherapists evaluated lymphedema and shoulder mobility at diagnosis,6 and 12months afterwards. The ALTJ, humeral head, and humeral head with asafety margin were delineated on aCT scan, and irradiation parameters were obtained from dose-volume histograms. Multivariate analysis confirmed acorrelation between higher mean (Dmean) and near-minimum (D98) radiation doses received by ALTJ and the incidence of lymphedema 12months post-diagnosis (p = 0.016 and p = 0.002, respectively). No significant association was found between the radiation dose to the humeral head and reduced mobility. In our cohort of patients, irradiation of the ALTJ region is associated with the occurrence of clinically-assessed lymphedema, while irradiation of the humeral head is not linked to limited mobility of the shoulder after breast cancer treatment.

Ayurveda has wide range of ideas on human body Rachana Sharir (anatomy) one of the important subjects among it. Rachana Sharir has very ancient origin and it look thousands of years to emerge in its present state. In Ayurvedic texts the human anatomy i.e. Rachana Sharir has been specially classified under sharirsthana of various samhitas due to this the part of the text completely committed about formation of human frame. The concept of marma is one of the important parts of Rachana Sharir. In Ayurvedic literature, Marma points are vital anatomical sites where muscles (mamsa), vessels (sira), ligaments (snayu), bones (asthi), and joints (sandhi) meet, and are considered the seats of life energy (prana). Apalapa Marma, located in the axillary region, is a significant marma described by Acharya Sushruta. Injury to this marma leads to loss of arm movements and even life-threatening conditions due to vascular and neurological involvement. In modern anatomical terms, this region corresponds closely with the course of the lateral thoracic artery, a branch of the second part of the axillary artery, supplying the lateral thoracic wall, serratus anterior, and pectoral region. The Apalapa Marma region anatomically corresponds to the lateral wall of the axilla where the lateral thoracic artery runs along with the long thoracic artery over the serratus anterior muscle. Injury to this region in cadaveric study revealed significant bleeding and potential nerve involvement leading to paralysis of the serratus anterior (winging of scapula), matching the viddha lakshana (clinical symptoms) mentioned for Apalapa Marma in Ayurvedic texts. This establishes a strong anatomical and clinical correlation between Apalapa Marma and the lateral thoracic artery. Understanding the correlation between Apalapa Marma and the lateral thoracic artery is essential for both marma chikitsa (therapeutic) and surgical approaches in the axillary region.

This case report investigates a rare variation of the axillary artery (AA) where most AA branches arose from a variant branch (VB) originating from the second part of the AA. It hopes to enhance the accuracy of surgical procedures on the upper limb and contribute to a more comprehensive understanding of AA anatomy. An Asian female cadaver was dissected, and the unique branching patterns of the AA was documented by photograph and illustration. The external diameter and the origin of the AA branches to the thoracoacromial artery (TAA) was measured by digital caliper. The VB originated from the AA at the level of the TAA, giving rise to the anterior and posterior circumflex humeral arteries (ACHA and PCHA). Additionally, the VB gave off a common trunk that branched into the circumflex scapular artery (CSA) and continued as the subscapular artery (SSA),which then divided into the lateral thoracic artery (LTA) and thoracodorsal artery (TDA). The VB had two terminal branches: the posterior terminal branch (PTB) coursing through the radial nerve tunnel, and the anterior terminal branch (ATB) descending along the inner side of the arm, passing through the medial side of the elbow, and supplying the forearm. The variants of the AA could be useful in surgical procedures that involve the lateral thorax, axilla and arm, contributing to a broader anatomical knowledge essential for radiographic, surgical, and other interventional procedures of the upper limb.

Mapping lateral chest wall perforators: A cadaveric study on anatomical details for oncoplastic breast surgery.

Recent advancements in medical technologies have made trans-arterial treatment of breast cancer feasible. Consequently, understanding the vascular anatomies of breast cancers and axillary lymph node metastases has become indispensable for sophisticated treatments. The aim of this study was to determine the vascular anatomy of the breast, which is crucial for trans-arterial chemoembolization in patients with breast cancer. A total of 126 treatment-naive breast cancer patients were investigated to evaluate the arteries supplying breast tissues, tumours, and axillary lymph node metastases. The breast-supplying arteries were identified via angio-CT scans performed in the same examination room. As described in anatomical textbooks, the main arteries supplying breast tissues and tumours are mammary branches arising from the internal thoracic artery and lateral thoracic artery. However, an undescribed serpiginous artery arising from the brachial artery distal to the subscapular artery and circumflex humeral artery was discovered in 46.0% of patients. This artery partially supplied breast tumours in 30.2% of the patients. The circumflex mammary artery is presumed to be a normal variant that is not pathologically enlarged due to tumour angiogenesis. Axillary lymph node metastases are supplied mainly by the lateral thoracic artery and thoracodorsal artery. We identified an undescribed serpiginous artery arising from the brachial artery distal to the subscapular artery or circumflex humeral artery, and we named this the circumflex mammary artery.

The arterial supply of the lateral wall of the chest is provided by branches of the axillary artery (AA), which is subdivided into three parts by the pectoralis minor muscle. Regarding the anatomical variation in the branches originating from the artery, axillary, when if treats from the artery thoracic side emerging as a branch of the subscapular artery has an incidence rate of approximately 3.9% (Loukas et al. , 2013). In this way, the subscapular artery generates its terminal branches described in the literature and also gives off the lateral thoracic artery, forming a trifurcation. Thus, this article aims to report an anatomical variation in the origin of the lateral thoracic artery of one individual of sex masculine, with focus in the explanation anatomical of the findings. Variations in the axillary artery and its branches are common and many of which they are documented in the literature, being this found described in the literature with an incidence of 3.9% (Gravante, 2012), this finding being important in treatment prior the procedures invasive from the region axillary.

Intraoperative ultrasound-guided breast-conserving surgery (IOUS) combined with chest wall perforator flaps (CWPFs) is a promising approach to avoid mastectomy, especially for patients with high anticipated resection-to-breast volume ratios (ARR) who would otherwise be ineligible for breast conservation. This study prospectively analyzed surgical, oncologic, and cosmetic outcomes for consecutive patients with stages 0 to III breast cancer who underwent IOUS with CWPF-based partial breast reconstruction at a single institution between 2022 and 2024. The study enrolled 73 female patients. The median age was 57 years, and the median tumor size was 32mm, with 43.8% of lesions being multifocal/multicentric. The median ARR was 30.2%. The flap types included lateral intercostal artery perforator (LiCAP, 53.4%), anterior intercostal artery perforator (AICAP, 8.2%), medial intercostal artery perforator (MICAP, 19.2%), lateral thoracic artery perforator (LTAP, 16.4%), and thoracodorsal artery perforator (TDAP, 2.7%). The median flap volume was 90cm3 (interquartile range [IQR], 47-140.5 cm), corresponding to 127% of the median specimens' volume (71.1cm3). The median operation time was 112min. The 30-day global complication rate was 16.4%. No flap losses occurred. The positive margin rate was 9.6%, requiring re-excisions (5.5%) and mastectomies (4.1%). Adjuvant radiotherapy was administered to 95.9% of the patients, with no flap-related complications. During a median follow-up period of 14 months, only one distant recurrence was experienced, and no deaths occurred. Both patient- and surgeon-assessed evaluations demonstrated excellent cosmetic outcomes. Lower scores were associated with postoperative complications, re-excisions, and horizontal scars. None of the patients would have preferred mastectomy, and 89% underwent CWPF-based surgery to avoid it. The combination of IOUS and CWPFs yielded favorable surgical, cosmetic, and short-term oncologic outcome. This approach effectively and safely expands the indications for breast conservation, avoiding mastectomies, particularly for patients with small-to-medium breasts and an unfavorable ARR.

PurposeTendon transfer of the pectoralis major (PM), pectoralis minor (Pm), latissimus dorsi (LD) and teras major (TM) is recommended for irreparable subscapularis (SSC) tears. This study aimed to describe the landmarks and neurovascular structures in the regions of the four muscles to facilitate their transfer to irreparable SSC tears.Study DesignDescriptive laboratory study.MethodsTwelve fresh‐frozen adult specimens were dissected and important neurovascular structures around the four tendons were identified. The relationships between the tendons and neurovascular structures were quantitatively investigated during tendon transfer procedures.ResultsThe average distance of medial pectoralis nerve (MPN) to the insertion of Pm on the coracoid was 6.5 cm (5.4–8.1 cm). The MPN travelled with the lateral thoracic artery (LTA) to pierce the PM with an average of 9.7 cm (8.3–12.1 cm) medial to the humeral insertion. Axillary nerve and posterior humeral circumflex vessels were above the superior margin of TM muscle with average of 0.8 cm (0.5–1.2 cm). These neurovascular structures crossed posterior to the plane of the LD and TM at 2.6 cm (1.9–3.3 cm) from the humeral insertion of these two muscles. The radial nerve (RN) and its motor branch to triceps were found to lie an average of 2.7 cm (2.0–4.3 cm) medial to the humerus at the superior border of the LD, and an average of 2.4 cm (1.8–3.5 cm) medial to the humerus at the inferior border of the TM. The neurovascular pedicles to the LD and TM were at an average of 12.7 cm (10.2–15.6 cm) and 7.0 cm (5.6–8.5 cm) to the humeral insertions, respectively.ConclusionsOur results clarify the complex local anatomic structures of the PM, Pm, LD and TM for tendon transfer to treat irreparable SSC tears and provide potentially useful references for tendon transfer.Level of EvidenceNot applicable.

Objective: A previous study suggested that the volume reduction rate in transplanted vascularized adipose tissue is directly affected by the capillary density rate in the tissue. The objective of this study was to investigate a novel method to maintain the volume of transplanted vascularized adipose tissue by administering drugs, believed to prevent or promote vascular occlusion, in the nutrient vessels of the adipose tissue. Methods: In an experimental Zucker fatty rat model, the axillary fat flap was elevated, using the lateral thoracic vessels as nutrient vessels. Normal saline, adrenaline, heparin sodium, and argatroban hydrate were administered through the lateral thoracic artery in 5 rats each; no drugs were administered in another 5. The fat flap volume was measured using computed tomography, and the fat flap was harvested for histologic examination and measurement of the capillary density rate through immunostaining. Results: Only the antithrombin drug, argatroban hydrate, yielded a fat flap volume change rate comparable to that of the nondrug group, and histologically, the morphology of the adipose tissue was preserved. The capillary density rate was highest in the argatroban hydrate group, although statistical analysis revealed a significant difference only between the argatroban hydrate group and adrenaline group. Regression analysis demonstrated a significant correlation between the capillary density rate and the rate of change in the transplanted fat flap volume. Conclusion: Argatroban hydrate administered through nutrient vessels may improve the capillary density rate within the transplanted fat flap and sustain the volume of the transplanted vascularized adipose tissue through nutrient vessel administration. This axillary fat flap may be valuable for future research on vascularized adipose tissue transplantation.

ObjectiveThis study aims to explore the application value of chest wall perforator flaps (CWPF) in oncoplastic breast-conserving surgery.MethodsA retrospective review was conducted on 22 early-stage breast cancer patients who underwent oncoplastic breast-conserving surgery using CWPF between January 2021 and December 2022. This included 4 cases (18.2%) utilizing lateral intercostal artery perforator (LICAP) flaps, 10 cases (45.4%) employing lateral thoracic artery perforator (LTAP) flaps, 4 cases (18.2%) combining LICAP and LTAP flaps, and 4 cases (18.2%) using anterior intercostal artery perforator (AICAP) flaps. The perforators used in this study included lateral thoracic artery perforators (LTAP), anterior intercostal artery perforators (AICAP), and lateral intercostal artery perforators (LICAP). In some cases, a combination of LICAP and LTAP was employed to ensure adequate blood supply. All flaps were supplied by dominant perforators, with some cases using multiple perforators to enhance flap perfusion and survival. Our single-center experience with CWPF, including surgical details, complications, aesthetic, and oncological outcomes, is reported.ResultsAmong all patients, tumors were located in the outer quadrant (68.2%), central quadrant (13.6%), and inner quadrant (18.2%) of the excision cavity. In the 22 patients, 15 tumors were located in the outer quadrant: 6 in the left upper outer quadrant (1–2 o’clock), 4 in the right upper outer quadrant (10–11 o’clock), and 5 in the outer quadrants (3 o’clock in 3 cases and 9 o’clock in 2 cases). Four tumors were in the lower inner quadrant: 2 in the left lower inner quadrant (7–8 o’clock) and 2 in the right lower inner quadrant (4–5 o’clock). Three tumors were in the central area extending toward the outer quadrant. All tumors were located more than 2 cm from the nipple-areola complex (NAC), and intraoperative frozen sections confirmed negative margins behind the NAC. All patients had negative surgical margins. The average operative time was 100.5 ± 10.2 min, with flap lengths ranging from 10 to 18 cm and widths from 4 to 10 cm. All flaps survived, with only one instance of surgical site infection, which improved with conservative treatment. Overall patient satisfaction was rated as excellent or good in 85.6%, and physician evaluation was 89.0% excellent or good. In addition to subjective patient and surgeon satisfaction surveys, objective aesthetic outcomes were evaluated using the BCCT.core software. This tool provided a standardized assessment of breast symmetry, contour, and cosmetic outcomes, enhancing the objectivity and reproducibility of the cosmetic evaluation in the study. The median follow-up period was 14.5 months, with one case of tumor recurrence and no patient mortality.ConclusionCWPF can be effectively used in small-to-medium volume, non-ptotic breasts for oncoplastic surgery, yielding high patient satisfaction. In the era of oncoplastic breast surgery, chest wall perforator flaps are a reliable and safe option for partial breast reconstruction with acceptable aesthetic results.

While alterations in the vasculature supplying the breast have been extensively recorded, there is no information on the direct breast branches of the axillary artery (AA). An elucidation of the direct breast branches may prove beneficial during mammoplasty. This study sought to investigate the anatomical characterization of breast vasculature utilizing three-dimensional (3D) technology to establish an anatomical foundation for therapeutic operations. Computed tomography images of 14 unilateral adult female breasts were conducted and rebuilt with Mimics software. The positioning of arteries in the breast area was also examined. The most consistently observed arterial supply to the breast was the perforating branch from the internal thoracic artery (100%), followed by the anterior intercostal artery (78.6%), the direct breast branch from the AA (71.4%), and the indirect breast branch from the lateral thoracic artery (28.6%). The direct breast artery (DBA) was classified into two categories based on the angle of origin of the AA: direct branching from AA (type I 40 %) and at an angle (type II 60 %). Furthermore, 80 % of the DBA were noted to be positioned laterally to the thoracic dorsal artery. 3D technology accurately delineates the arterial distribution in the breast area at high resolution to inform clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The lateral thoracic artery (LTA) is one of six main branches that originate from the axillary artery. The LTA has a textbook origin from the 2nd part of the axillary artery posterior to the pectoralis minor muscle. Contrary to the textbook origin, there are numerous reports of LTA variants that originate from the thoracoacromial artery, subscapular artery, and thoracodorsal artery, or even its duplication. This case report involves description of an additional unique duplicate variant of the LTA, bilaterally. The right duplicate LTA has its origin from the 3rd part of the axillary artery and then courses with the axillary sheath before coursing towards the breast. The right duplicate LTA variant also gives off two small subcutaneous branches in the medial upper arm. The left duplicate LTA has its origin from the brachial artery and courses directly to the breast through the axilla. Additional detail on the variants of the LTA could prove useful in surgical procedures that involve the lateral thorax, chest, and axilla and contribute to broader anatomical knowledge.

Background:Breast hypertrophy is a condition of increased breast volume, occurring at different ages, causing many psychological and physiological problems such as back pain, inflammation of the inframammary folds, and psychological stress1Objective:This study aimed to identify the main arterial sources of blood supply to the nipple-areola complex (NAC), which may apply to extensive hypertrophic breast reduction surgeries.Methods:Describe a cross-sectional, uncontrolled clinical case series to evaluate the most accurate blood supply to the NAC based on angiography for all patients diagnosed with excessive breast enlargement requiring surgery.Results:30 female patients were diagnosed with hypertrophic breasts with a minimum volume of 1005cc and a maximum of 2412 cc. Multi-slice computed tomography (MSCT) was indicated preoperatively to determine the blood supplies to the breast; the internal mammary artery (IMA) predominates in 60/60 breasts (100%), and the lateral thoracic artery predominates in 21/60 breasts (35%). Based on the MSCT scan results, the axial flap design carrying the NAC complex has a dominant branch entirely from the IMA: superior medial pedicle in 48/60 breasts (80%), superior pedicle in 11/60 breasts (18.33%) and medial pedicle in 1/60 breasts (1.67%). None of the breasts showed signs of nipple-areola necrosis after surgery, and only two cases (3.3%) of partial NAC necrosis occurred, both in superior flaps.Conclusion:Preoperative breast MSCT imaging helps select the type of pedicle that supplies blood to the NAC and minimizes the risk of NAC necrosis during breast reduction surgery in cases of significant hypertrophy and severe grades of ptosis.

Arterial variations in the upper limb are of significant clinical importance, especially in procedures such as venepunctures, coronary artery bypass grafts, trauma reconstructive surgeries, brachial plexus nerve blocks, and breast reconstructions. This report presents previously undocumented arterial variations in the upper limbs in a 95-year-old female cadaveric donor. We observed bilateral superficial ulnar arteries originating at the cubital fossa, deviating from the previously reported origin at the proximal brachial artery. We found additional variations in the branches of the axillary artery: on the right side, two superior thoracic arteries emerged from the first part of the axillary artery, an accessory branch supplied the subscapular muscle, and the large subscapular artery arising from the third part of the axillary artery gave rise to both the lateral thoracic and posterior circumflex humeral arteries. On the left side, a common trunk was identified, giving rise to the transverse cervical, dorsal scapular, and accessory lateral thoracic and subscapular arteries. Moreover, the acromial artery originated directly from the axillary artery on both sides. This case report discusses the clinical significance of these unique vascular anatomical variants, their prevalence, and potential impact, emphasizing the importance for clinicians to be aware of such variations to enhance surgical planning and patient safety.

Background: Spinal cord ischemia is one of the most serious complications after an aortic repair. To date, there is no evidence for arterial changes during an aortic dissection or for the observation of such arteries after an aortic repair. The aim of this study was to compare spinal-cord-supplying arteries in patients with an acute aortic dissection, preoperatively and postoperatively, with patients without an acute aortic dissection. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure to treat an aortic dissection and 25 patients who qualified for a transcatheter aortic valve replacement without an acute aortic dissection and atherosclerosis of the analyzed vessels, treated as a control group, were reconstructed and retrospectively analyzed with the detailed medical data of the patients. The aortic branches with the ability to supply blood to the spinal cord as described in the literature were further analyzed. Results: The preoperative arterial diameters of the left internal thoracic artery, the left musculophrenic artery, and the left and right supreme intercostal arteries were significantly larger compared to the postoperative measurements. In addition, the preoperative measurements of the diameters of the left vertebral artery, right internal thoracic artery, left lateral thoracic artery, and left common iliac artery were significantly larger than in the control group. Conclusions: The internal thoracic arteries and supreme intercostal arteries may play a crucial role in providing additional blood supply to the spinal cord.

Objective: This study explores the anatomical variations and characteristics of the lateral thoracic artery (LTA) and its perforators through thoracic computed tomographic angiographies (CTA) and cadaveric dissection, aiming to enhance surgical planning and patient outcomes. Materials and Methods: Data were recorded for both thoracic CTA patients (n = 40) and soft cadavers (n = 13) for subsequent retrospective analyses of biological sex, age, body mass index (BMI), LTA characteristics (length, diameter, origin, number of perforators, number of lymph nodes), and locations (rib level and distance from the pectoralis major, latissimus dorsi, and acromioclavicular joint). Results: Average LTA parameters for thoracic CTAs were 89.6 millimeters in length from origin and 2.1 millimeters in diameter, while cadavers were 117.0 millimeters in length and 2.3 millimeters in diameter. At least 1-2 cutaneousperforators and 1 proximal lymph node were found across both thoracic CTAs and cadavers. No significant differences were observed between the left and right sides for both groups. On average, 73.8% and 66.4% of LTAs from thoracic CTAs and cadavers, respectively, originated from the axillary artery. Conclusion: This knowledge is crucial for surgical planning, both to minimize damage to the LTA and ensure the inclusion of its perforators and proximal lymph nodes in the lateral thoracic region. The researchers recommend lateral thoracic artery perforator flap harvest between the lateral border of the pectoralis major and the anterior border of the latissimus dorsi, specifically above the 3rd-6th ribs, which is correlated to the length of LTA at 89.6-117 millimeters from origins.

Although breast blood supply comes from the internal mammary, lateral thoracic, and intercostal artery perforators, the nipple-areola complex (NAC) blood supply was usually depicted as a direct continuation of those vessels rather than a true description based on anatomical research. Studies focusing on NAC vascularity are few in number, done on a limited number of subject based on microdissection, computed tomography, or MRI. The results are inconsistent and may be perplexing. Hence, the need for studies on a large number of living subject is still warranted. Because duplex proved efficient at detecting perforators, we used it to assess NAC vascularity. In vivo delineation of NAC blood supply by comparing this to the nipple-to-suprasternal notch (N-SN) distance and individual variation between both sides. Female subject presenting to the Breast Imaging Unit of the institute (229 subject; 458 breasts, BIRADS I and II) were assessed by duplex for the presence of significant NAC blood supply (≥1 mm), regarding their number, source vessel, perforator level, relation to N-SN distance, and similarity between both sides. The third and fourth internal mammary artery (IMA) perforators accounted for 54.8% and 31.3%, respectively. The second IMA, lateral thoracic artery, and direct axillary branch were found in 9.2%, 3.3%, and 1.3%, respectively. The longer the N-SN distance is, the lower the supplying perforator. NAC vascularity was symmetric in 143 subject (62.4%) and asymmetric in 86 subject (37.5%). The third and fourth internal mammary perforators are the main source of NAC blood supply. Right and left sides' asymmetry is not uncommon. Finally, the longer the N-SN distance is, the lower the perforator level is anticipated.

The introduction of pedicled chest wall perforator flaps (CWPF) in breast surgery, increased the options for oncoplastic volume replacement procedures, however, the literature is scarce on nonblind nonrandomized interventional studies comparing intercostal artery perforator (ICAP) flaps versus lateral thoracic artery perforator (LTAP) flaps in Partial breast reconstruction. This research was designed to assess the ICAP flaps versus the LTAP flaps in partial breast reconstruction in small and medium-sized breast women, in terms of aesthetic outcomes, patient satisfaction, and perioperative complications. Patients and Methods: This study was a nonblind nonrandomized interventional study, conducted on 34 female cases with early breast cancer, who underwent conservative breast surgery and partial reconstruction, either by the ICAP flaps or the LTAP flap. Results: In this study, 34 cases were allocated to 20 patients in the ICAP flaps group, and 14 cases in the LTAP flaps group. The mean total follow-up period was 33.10±11.96 versus 12.15±10.92, P less than 0.001 * . The average age was 40.60±8.62 versus 43.07±8.01, and the average BMI was 32.19±6.80 versus 33.74±4.60 for the ICAPs versus LTAP groups, respectively. The most common complications encountered were marked seroma, experienced by 5 cases in the two groups without statistically significant difference. Overall, the aesthetic outcomes were good to excellent in over 90% of the cases in the two groups without statistically significant difference, P=0.608. Most of the cases were very satisfied with the aesthetic outcomes (n=19, 95.0%) versus (n=12, 85.7%) for the ICAP versus the LTAP flaps, respectively without statistically significant differences, P=0.455. The ICAP and the LTAP flaps are both versatile, risk-free surgical techniques, associated with low complications rate, very good to excellent aesthetic outcomes, and a high patient satisfaction rate.