Scapular Artery Research Articles

Proposition d’un algorithme en cas de vaisseaux mammaires internes inutilisables lors d’une reconstruction mammaire par DIEP

We analyzed the strategy of microvascular connection during the DIEP in case of unusable internal mammary vessels in intraoperative period. It is about five cases of mammary reconstructions by DIEP practiced in a plastic surgery department. We modified our connections because the quality of the artery and/or the vein was considered insufficient. In case of internal mammary artery unusable, we changed the donor site and the flap was anastomosed with circumflexe scapular vessels. In case of internal mammary vein judged unusable but with usable artery, we anastomosed the DIEP with the internal mammary artery and with the cephalic vein. We added a venous substitution by the second connection with the deep inferior epigastric venous by coupler's technique. Circumflexe scapular artery was the first alternative of internal mammary artery. In every case we protected the thoracodorsal pedicle.

A case of an extremely rare unilateral subscapular trunk and axillary artery variation in a male Caucasian: Comparison to the prevalence within other populations

A male Caucasian cadaver was found to have a large common trunk that branched off of the first part of the axillary artery of the left arm. This trunk gave rise to all but two arterial branches of the axillary region. The large common trunk first gave off a thoracoacromial artery followed by the main branch, the subscapular artery. The subscapular was the origin of the posterior circumflex humeral and lateral thoracic arteries immediately proximal to bifurcating into its two terminal branches, the circumflex scapular and thoracodorsal arteries. Only the superior thoracic and anterior circumflex humeral arteries arose directly from the axillary artery. Also found was a high origin of the radial artery, noteworthy by its serpentine route. In comparison, in the right arm, no variants appeared in the axillary, subscapular, or brachial arteries. A comparison with branching patterns of axillary arteries from demographically similar and dissimilar populations revealed the extreme rarity of this set of anomalies.

Coarctation of the aorta, hypertension and associated features

A 17-year-old female athlete who had a black belt in Tai-Kwondo was discovered to be hypertensive (blood pressure recorded as 150/90 mmHg in both arms) when she was screened to join a new gym. Although able to perform physical contact sports to a competitive level without apparent symptoms, direct enquiry revealed that she had calf pain on jogging. On examination a grade 4/6 systolic murmur was audible throughout the precordium. Femoral pulses were impalpable bilaterally. Routine blood tests including renal function were all normal as was a renal ultrasound and urine analysis for protein and catecholamines. The electrocardiogram showed sinus rhythm, a normal axis and satisfied voltage criteria for left ventricular hypertrophy. A transthoracic echocardiogram was normal, with no evidence of left ventricular hypertrophy and good biventricular systolic function. However, on examination of flow in the abdominal aorta there was continuous forward flow throughout the cardiac cycle. The chest X-ray (Figure 1) showed rib notching as a result of erosive pressure on the ribs from collateral blood flow in large vessels derived from the subclavian, axillary, internal thoracic, scapular and intercostal arteries. Cardiac magnetic resonance imaging confirmed the diagnosis of coarctation of the aorta (Figure 2), explaining the continuous abdominal aortic blood flow. The murmur was the result of turbulent blood flow through an isolated, typical post-ductus location, coarctation of the thoracic aorta. The diameter at its narrowest was 0.6 cm. The femoral pulses were impalpable as the flow at the femoral arteries was reduced and continuous in character (as demonstrated by the echo study) rather than pulsatile and palpable.

Use of circumflex scapular vessels as a recipient pedicle for autologous breast reconstruction: a report of 40 consecutive cases.

The use of the circumflex scapular pedicle as a recipient vessel for breast reconstruction in a series of 40 consecutive cases in 37 patients is reported. There were 3 bilateral reconstructions and 34 unilateral reconstructions. Twenty-one cases were immediate reconstructions, and 19 cases were secondary reconstructions. The diameter of the artery varied from 1.5 mm to 3 mm and systematically matched with the diameter of the epigastric artery. The artery was a branch of the subscapular system in 82.5 percent of cases (33 of 40). In 17.5 percent of cases (7 of 40), the artery was a direct branch of the axillary artery. The length of available pedicle between the axillary vessel and the distal part where it can be divided (on its division between scapular and parascapular artery) was of 76 +/- 13 mm for the artery and 72 +/- 12 mm for the vein. The vein was unique in 77.5 percent of cases. The diameter was similar to the artery diameter when unique. There was a dual venous system in 21 of 40 cases (52.5 percent) but in 15 cases (37.5 percent), one of the two veins was dominant. In the seven cases for which the veins were dual and of equivalent diameter, the epigastric veins were also dual and allowed a second anastomosis. Clinically, the anastomosis was always possible on the artery. In one case of reconstruction after Halstedt mastectomy, no vein could be found, because all the veins had been ligated previously. One venous thrombosis (2.5 percent) and one arterial thrombosis were experienced. Both were treated by revised anastomoses and did not compromise late results. The circumflex scapular pedicle is a reliable and simple recipient site for breast reconstruction. It allows a unique site of dissection in immediate reconstruction and avoids division of the thoracodorsal pedicle. The technique is now used exclusively at this institution.