Anatomy And Classification Of The Thoracic Dorsal Artery Perforator Flap

Objective:To obtain the anatomical data of the thoracic dorsal artery perforator flap.Based on the anatomical results,the thoracic dorsal artery perforator flap was classified.The classification of the thoracic dorsal artery perforator flap was used to guide the clinical operation of the thoracic dorsal artery perforator flap.Methods:20 sides specimens from 17 fresh specimens were randomly selected,and the artery was perfused with red latex.The thoracic dorsal artery perforator flap was designed.The anatomical range extends from the axilla to the upper margin of the latissimus dorsi,to the lower part of the 10th rib,to the lateral margin of the latissimus dorsi,and to the medial margin of the latissimus dorsi.All perforators within the scope of the thoracic dorsal artery perforator flap were observed anatomic,and the sources of each perforator were determined.The number of perforators from different sources of each specimen was counted.The diameter of the perforator was measured with a microruler under a microscope,and each vessel was averaged three times.The number of perforators greater than or equal to 0.5mm and the number of perforators less than 0.5mm were counted,and all specimens were analyzed and classified.Results:In this experiment,17 specimens were dissected on 20 sides,among which,there were at most 33 perforators and at least 5 perforators.The thoracic dorsal artery perforated with at most 25 perforators and at least 1 perforator.The diameter range of the thoracic dorsal artery perforators is 0.12mm to 1.02mm.The dominant artery was the perforating artery of greater than 0.5mm,and there were 58 dominant perforating arteries of the thoracic dorsal artery,with an average of 2.90±2.22(range 0-7).Among all the specimens,17 of them had a thoracodorsal artery perforation greater than or equal to 0.5mm,accounting for 85%.All perforations of the thoracic dorsal artery in the 3 specimens were less than 0.5mm,accounting for 15%.Specimens of one side of the thoracic dorsal artery perforators number is 1,0.43 mm in diameter,but there are 10 perforators from intercostals arteries,intercostals arteries in the range of 0.53-1.09 mm in diameter,and 1 from the lateral thoracic artery,diameter of 0.40 mm,1 from the scapular circumflex artery diameter of 0.82 mm,this side is mainly composed of intercostals arteries and circumflex scapular artery dual supply;1side of specimens have 2 lateral thoracic dorsal artery perforators,diameter of 0.35 mm and 0.44 mm respectively,in addition to 1 thoracic dorsal artery saw muscle perforators,diameter of 0.87 mm,but perforated position is in the edge of the range,have little impact on the flap blood supply,intercostals perforators have 10 artery,range 0.56-1.04 mm,flap blood supply is mainly supplied by intercostals arteries;In addition,there were a large number of thoracic dorsal artery perforators(25)in one side of the specimen,but the diameter of the perforators was small,ranging from 0.19 to 0.45mm,while the number of intercostal artery perforators was less than that of the thoracic dorsal artery(8),and the diameter was also small,ranging from 0.28 to 0.45mm.The blood supply of the flap was mainly from the thoracic dorsal artery.Therefore,all the specimens with perforators less than 0.5mm of the 3 sides of the thoracic dorsal artery can be divided into two situations:one is that the peripheral artery puncture branches are the main blood supply source of the flap,accounting for 10%;The other is the main source of blood supply,but the dorsal thoracic artery is scattered and small,accounting for 5%.Conclusion:According to the number,diameter and other sources within the flap range,the thoracic dorsal artery flap can be divided into three types:1.Common type:The superior artery perforators of the thoracic dorsal artery is greater than or equal to 0.5mm,and the blood supply in the flap area is mainly the artery perforators of the thoracic dorsal artery.This type of flap accounted for 85%in this experiment.The flap can be removed clinically with a high success rate.2.Peripheral arteries type:all the perforators of the thoracic dorsal artery were small ones less than 0.5mm,and the number was rare(there were 2 sides in this experiment,namely 1 branch and 2 branch),but the perforators of the peripheral artery were large and abundant,and the blood supply in the flap area was mainly from the peripheral artery.In this study,the blood supply of 1 side of the sample was mainly provided by intercostal artery perforations,while the blood supply of 1 side of the sample was provided by intercostal artery perforations and scapular artery perforations.This type accounted for 10%in this study.Clinically,the perforator flap of the dorsal thoracic artery cannot be removed or the flap is not easy to survive after removal,but the perforator flap with the large perforator of the peripheral artery as the vascular pedicle can be removed instead.3.Dispersed type:The blood supply in the flap area is mainly from the perforators of the thoracic dorsal artery,but the perforators of the thoracic dorsal artery are all small ones less than 0.5mm,and there are a large number of them(25 in this experiment).Meanwhile,the perforators from other sources are also small.This type accounted for 5%of the patients in this study.Clinically,the dorsal thoracic artery perforator flap cannot be removed,and no other vascular perforator flap can be removed.The latissimus dorsi musculocutaneous flap with latissimus dorsi muscle can only be used to complete the operation.