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Variations of the thoracodorsal axis: application for scapular tip free flap harvesting

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Abstract

Purpose

To illustrate variations of the vascular anatomy of the subscapular system highlighting practical implications on surgical access, patient positioning, and strategies to maximize the exposure of vascular pedicle.

Methods

A retrospective review of patients undergoing reconstruction with a scapular tip free flap over a 2-year period at a tertiary referral center.

Results

Forty patients were included. In 25 (62.5%) cases, the thoracodorsal artery (TD) ended bifurcating into latissimus dorsi (LD) and angular branch (AB), with the serratus artery branch arising from the LD pedicle; this vascular pattern was defined as “LD-dominant.” In 10 (25%) cases, the TD bifurcated into LD and AB, with the serratus artery branch arising from the latter vessel, defined as “AB-dominant.” Lastly, there was a trifurcation pattern in 5 (12.5%) patients. There was considerable variability in the distal branching pattern. Twenty-two (55%) patients had 2 LD branches; in 11 (27.5%) cases, there was only 1 LD branch, and 7 (17.5%) cases had 3. Thirty-seven patients (92.5%) had 1 AB; in the remaining three cases (7.5%), there were 2. The entry point of AB was located 4.86 cm (mean) ± 0.75 cm from the fibrous tip. The arm positioning and scapular retraction were the key maneuvers to facilitate pedicle exposure and dissection, with the shoulder abducted and scapula retracted away from the body.

Conclusion

The subscapular vascular anatomy is highly variable. Knowledge of anatomic variability alongside surgical pearls to harvest STFF could facilitate the introduction of this flap into the toolkit of head and neck reconstructive teams.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine & Dentistry, London Health Sciences Centre, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    Axel Sahovaler, Francisco Laxague, Eun-Jae Chung, Kevin Fung, S. Danielle Mac Neil, Anthony C. Nichols & John Yoo

  2. Head & Neck Surgery, University College London Hospitals, London, UK

    Axel Sahovaler

  3. Sydney Head and Neck Cancer Institute, Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney, NSW, Australia

    Hubert Low

Authors
  1. Axel Sahovaler
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  2. Hubert Low
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  3. Francisco Laxague
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  4. Eun-Jae Chung
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  5. Kevin Fung
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  6. S. Danielle Mac Neil
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  7. Anthony C. Nichols
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  8. John Yoo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Axel Sahovaler, John Yoo, and Francisco Laxague. The first draft of the manuscript was written by Axel Sahovaler, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Francisco Laxague.

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Ethical approval was obtained by the Institutional Review Board of our institution.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1; 2; 3a, 3b, and 3c; and 4a, 4b, and 4c.

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The authors declare no competing interests.

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Sahovaler, A., Low, H., Laxague, F. et al. Variations of the thoracodorsal axis: application for scapular tip free flap harvesting. Oral Maxillofac Surg 26, 619–623 (2022). https://doi.org/10.1007/s10006-021-01037-8

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  • DOI: https://doi.org/10.1007/s10006-021-01037-8

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