Advertisement

Anatomical study of the perforator flap based on the acromial branch of the thoraco-acromial artery (abTAA flap): a cadaveric study

  • Anne-carole Portenard
  • Isabelle Auquit-Auckbur
  • Ludivine Gardeil
  • Bénédicte Elbaz
  • Alice Carricaburu
  • Fabrice DuparcEmail author
Original Article
  • 16 Downloads

Abstract

Purpose

The aim of this anatomical study was to describe a local perforator flap, for covering shoulder defects, by determining the features of the acromial branch of the thoraco-acromial artery (abTAA), and the supplied cutaneous area.

Methods

Thirteen fresh cadaveric thoraxes were dissected bilaterally. A precise and reproducible protocol was performed. For each abTAA flap cadaveric dissection, the following parameters were measured after arterial injection: distances between the origin of the perforator artery on the abTAA and the sternum, the acromion, the clavicle, diameter of the perforator artery of the abTAA, length of the perforator pedicle course through major pectoralis muscle, and rotation arc. We also calculated the surface of the injected skin paddle. These measurements were related to morphometric parameters evaluated through the distance between sternum and acromion.

Results

The mean distances measured from the origin of the perforator artery on the abTAA were 14.25 cm to the sternum, 3.45 cm to the acromion, 5.65 cm to the clavicle. The mean diameter of the abTAA was 1.20 mm ± 0.2. The arc of rotation was 180°, and the length of the perforator pedicle could be extended to 7.46 cm ± 1.15. We observed an colored elliptical cutaneous paddle with a longer radius 18 cm and a small radius 15 cm.

Conclusions

Our results suggest that this type of flap could be useful in clinical practice for reconstruction and covering of the acromial area with a thin cutaneous flap with low sequelae on the donor site.

Keywords

Perforator flap Shoulder flap Thoracoacromial artery Acromial branch Shoulder injuries Anatomical study 

Notes

Author contributions

ACP: Manuscript writing—Data collection—Data analysis. FD: Protocol development—Data collection—Manuscript editing. IAA: Data management. LG: Data collection. BE: Data collection. AC: Manuscript editing

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Chaput B, Grolleau JL, Garrido I et al (2017) Delayed procedure in propeller perforator flap: defining the venous perforasome. J Plast Reconstr Aesthet Surg 70:286–289.  https://doi.org/10.1016/j.bjps.2016.11.011 CrossRefGoogle Scholar
  2. 2.
    Cormack GC, Lamberty BGH (1995) The arterial anatomy of skin flaps. Churchill Livingstone, EdinburghGoogle Scholar
  3. 3.
    Gandolfi S, Auquit-Auckbur I, Poirot Y et al (2018) Focus on anatomical aspects of soft tissue coverage options in elbow reconstruction: an updating review. Surg Radiol Anat.  https://doi.org/10.1007/s00276-018-2066-5 Google Scholar
  4. 4.
    Geddes CR, Tang M, Yang D, Morris SF (2003) An assessment of the anatomical basis of the thoracoacromial artery perforator flap. Can J Plast Surg J Can Chir Plast 11:23–27CrossRefGoogle Scholar
  5. 5.
    Hallock GG (2011) The island thoracoacromial artery muscle perforator flap. Ann Plast Surg 66:168–171.  https://doi.org/10.1097/SAP.0b013e3181dc83cd CrossRefGoogle Scholar
  6. 6.
    Halmy C, Szetei K, Nádai Z et al (2009) Posterior circumflex humeral artery perforator flap (PCHAP-flap) in axillary scar release. Orv Hetil 150:603–606.  https://doi.org/10.1556/OH.2009.28556 CrossRefGoogle Scholar
  7. 7.
    Hamdi M, Stillaert FBJL (2010) Pedicled perforator flaps in the trunk. Clin Plast Surg 37(655–665):vii.  https://doi.org/10.1016/j.cps.2010.06.004 Google Scholar
  8. 8.
    Haq EU, Javaid RH, Hameed S et al (2015) Thoracodorsal artery perforator flap for upper limb reconstruction. J Ayub Med Coll Abbottabad 27:451–457Google Scholar
  9. 9.
    Izadi D, Paget JT-EH, Haj-Basheer M, Khan UM (2012) Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconstr Aesthetic Surg 65:1357–1362.  https://doi.org/10.1016/j.bjps.2012.04.032 CrossRefGoogle Scholar
  10. 10.
    Katsuragi Y, Katagiri H, Nagamatsu S et al (2010) Combined sliding flap using a single perforator enables simple closure of the donor site: a case report. J Plast Reconstr Aesthetic Surg 63:e543–e546.  https://doi.org/10.1016/j.bjps.2009.11.017 CrossRefGoogle Scholar
  11. 11.
    Kim JT, Kim SW (2015) Perforator flap versus conventional flap. J Korean Med Sci 30:514–522.  https://doi.org/10.3346/jkms.2015.30.5.514 CrossRefGoogle Scholar
  12. 12.
    Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648CrossRefGoogle Scholar
  13. 13.
    Kosutic D (2010) Use of pectoralis major perforators for local “free-style” perforator flap in axillary reconstruction: a case report. Microsurgery 30:159–162.  https://doi.org/10.1002/micr.20711 Google Scholar
  14. 14.
    Lachica RD (2012) Resurfacing a traumatic upper extremity contour deformity: a new application of the free superior gluteal artery perforator flap. Plast Reconstr Surg 129:210e–212e.  https://doi.org/10.1097/PRS.0b013e3182365d28 CrossRefGoogle Scholar
  15. 15.
    Lee K-T, Mun G-H (2014) A systematic review of functional donor-site morbidity after latissimus dorsi muscle transfer. Plast Reconstr Surg 134:303–314.  https://doi.org/10.1097/PRS.0000000000000365 CrossRefGoogle Scholar
  16. 16.
    Manchot (2011) Die Hautarterien des menschlichen Körpers: [Reprint of the Original from 1889] (German Edition). EOD Network (May 6, 2011)Google Scholar
  17. 17.
    Mojallal ABF (2015) Atlas des artères perforantes cutanées du tronc et des membres. Elsevier, ParisGoogle Scholar
  18. 18.
    Nail-Barthelemy R, Stroumza N, Qassemyar Q et al (2018) Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis. Ann Chir Plast Esthet.  https://doi.org/10.1016/j.anplas.2018.01.003 Google Scholar
  19. 19.
    Ooi ASH, Butz DR, Teven CM, Gottlieb LJ (2018) Re-introducing the delto-acromial perforator flap: clinical experience and cadaver dissection. J Plast Reconstr Aesthet Surg 71:402–409.  https://doi.org/10.1016/j.bjps.2017.08.029 CrossRefGoogle Scholar
  20. 20.
    Qassemyar Q, Havet E, Sinna R (2012) Vascular basis of the facial artery perforator flap: analysis of 101 perforator territories. Plast Reconstr Surg 129:421–429.  https://doi.org/10.1097/PRS.0b013e31822b6771 CrossRefGoogle Scholar
  21. 21.
    Rout DK, Nayak BB, Choudhury AK, Pati AK (2014) Reconstruction of high voltage electric burn wound with exposed shoulder joint by thoracoacromial artery perforator propeller flap. Indian J Plast Surg Off Publ Assoc Plast Surg India 47:256–258.  https://doi.org/10.4103/0970-0358.138971 Google Scholar
  22. 22.
    Saint-Cyr M, Schaverien MV, Rohrich RJ (2009) Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 123:132e–145e.  https://doi.org/10.1097/PRS.0b013e31819f2c6a CrossRefGoogle Scholar
  23. 23.
    Saint-Cyr M, Wong C, Schaverien M et al (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 124:1529–1544.  https://doi.org/10.1097/PRS.0b013e3181b98a6c CrossRefGoogle Scholar
  24. 24.
    Salmon M, Taylor GI, Tempest MN (1988) Arteries of the skin, 1st edn. Churchill Livingstone, LondonGoogle Scholar
  25. 25.
    Seikaly H, Moshaver A, Chau J et al (2007) Clavipectoral osteomyocutaneous free flap in oromandibular reconstruction. J Otolaryngol 36:186–190CrossRefGoogle Scholar
  26. 26.
    Song DJ, Li Z, Zhou X et al (2018) Clinical application of modified bilobed chimeric thoracoacromial artery perforator flap for reconstruction of hypopharyngeal defect with anterior neck skin loss. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 53:364–368.  https://doi.org/10.3760/cma.j.issn.1673-0860.2018.05.007 Google Scholar
  27. 27.
    Stillaert FB, Casaer B, Roche N et al (2008) The inframammary extending lateral intercostal artery perforator flap for reconstruction of axillary contractures: a case report. J Plast Reconstr Aesthet Surg 61:e7–e11.  https://doi.org/10.1016/j.bjps.2008.03.070 CrossRefGoogle Scholar
  28. 28.
    Taylor GI (2003) The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 30(331):342Google Scholar
  29. 29.
    Turner AJ, Haywood RM (2008) Extending the reach of the thoracodorsal artery perforator flap for coverage of the shoulder. J Plast Reconstr Aesthet Surg 61:989–990.  https://doi.org/10.1016/j.bjps.2007.10.073 CrossRefGoogle Scholar
  30. 30.
    Yousif NJ, Ye Z, Grunert BK et al (1998) Analysis of the distribution of cutaneous perforators in cutaneous flaps. Plast Reconstr Surg 101:72–84CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Hand SurgeryRouen University HospitalRouenFrance
  2. 2.Department of Orthopedic SurgeryRouen University HospitalRouenFrance
  3. 3.Laboratory of Anatomy, Faculty of Medicine-PharmacyRouen UniversityRouenFrance

Personalised recommendations