The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.

<h4>Background</h4>Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral t...

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Autores principales:	Yu Kagaya, Masaki Arikawa, Takuya Sekiyama, Hideyuki Mitsuwa, Ryo Takanashi, Marie Taga, Satoshi Akazawa, Shimpei Miyamoto
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/09099f43693a48d9b800586151f73532
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spelling	oai:doaj.org-article:09099f43693a48d9b800586151f735322021-12-02T20:08:33ZThe concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.1932-620310.1371/journal.pone.0256962https://doaj.org/article/09099f43693a48d9b800586151f735322021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256962https://doaj.org/toc/1932-6203<h4>Background</h4>Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new "whole perforator system" (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner.<h4>Methods</h4>We first performed an anatomical study that verified the number and perforating points of all perforators around the LD lateral border using the results of dynamic contrast-enhanced magnetic resonance imaging of patients with breast cancer. Following the anatomical evaluation, we performed large muscle-preserving flap transfer that contained all of the perforators around the LD lateral border in an actual clinical setting.<h4>Results</h4>A total of 175 latissimus dorsi from 98 patients were included. The mean number of perforators (TDAP-sc + TDAP-mp + LTAP) per side was 4.51±1.44 (2-9); TDAP-sc was present in 57.1% (100/175) of cases, and TDAP-mp in 76.6% (134/175); the TDAP total prevalence rate (TDAP-sc + TDAP-mp) was 96.0% (168/175). The LTAP existence rate was 94.3% (165/175). Distance from the axillary artery to the TDAP-sc was 148.7±56.3 mm, which was significantly proximal to the TDAP-mp (183.8±54.2 mm) and LTAP (172.2±81.3 mm).<h4>Conclusion</h4>The lateral thoracic region has an abundant cutaneous perforator system derived from the descending branch of the thoracodorsal and lateral thoracic arteries. Clinical application of the lateral thoracic WPS flap is promising, with a large survival area even with muscle-preserving procedures and requiring a relatively simple procedure.Yu KagayaMasaki ArikawaTakuya SekiyamaHideyuki MitsuwaRyo TakanashiMarie TagaSatoshi AkazawaShimpei MiyamotoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256962 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yu Kagaya Masaki Arikawa Takuya Sekiyama Hideyuki Mitsuwa Ryo Takanashi Marie Taga Satoshi Akazawa Shimpei Miyamoto The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
description	<h4>Background</h4>Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new "whole perforator system" (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner.<h4>Methods</h4>We first performed an anatomical study that verified the number and perforating points of all perforators around the LD lateral border using the results of dynamic contrast-enhanced magnetic resonance imaging of patients with breast cancer. Following the anatomical evaluation, we performed large muscle-preserving flap transfer that contained all of the perforators around the LD lateral border in an actual clinical setting.<h4>Results</h4>A total of 175 latissimus dorsi from 98 patients were included. The mean number of perforators (TDAP-sc + TDAP-mp + LTAP) per side was 4.51±1.44 (2-9); TDAP-sc was present in 57.1% (100/175) of cases, and TDAP-mp in 76.6% (134/175); the TDAP total prevalence rate (TDAP-sc + TDAP-mp) was 96.0% (168/175). The LTAP existence rate was 94.3% (165/175). Distance from the axillary artery to the TDAP-sc was 148.7±56.3 mm, which was significantly proximal to the TDAP-mp (183.8±54.2 mm) and LTAP (172.2±81.3 mm).<h4>Conclusion</h4>The lateral thoracic region has an abundant cutaneous perforator system derived from the descending branch of the thoracodorsal and lateral thoracic arteries. Clinical application of the lateral thoracic WPS flap is promising, with a large survival area even with muscle-preserving procedures and requiring a relatively simple procedure.
format	article
author	Yu Kagaya Masaki Arikawa Takuya Sekiyama Hideyuki Mitsuwa Ryo Takanashi Marie Taga Satoshi Akazawa Shimpei Miyamoto
author_facet	Yu Kagaya Masaki Arikawa Takuya Sekiyama Hideyuki Mitsuwa Ryo Takanashi Marie Taga Satoshi Akazawa Shimpei Miyamoto
author_sort	Yu Kagaya
title	The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
title_short	The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
title_full	The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
title_fullStr	The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
title_full_unstemmed	The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.
title_sort	concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: an anatomical study and case series.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/09099f43693a48d9b800586151f73532
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The concept of "whole perforator system" in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series.

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