Top

Published in:

Open Access 12-09-2022 | Original Article

The thoracoacromial trunk: a detailed analysis

Authors: Michał Bonczar, Kamil Gabryszuk, Patryk Ostrowski, Jakub Batko, Daniel Jakub Rams, Agata Krawczyk-Ożóg, Wadim Wojciechowski, Jerzy Walocha, Mateusz Koziej

Published in: Surgical and Radiologic Anatomy | Issue 10/2022

Abstract

Purpose

The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps.

Methods

A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed.

Results

A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made.

Conclusion

In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.

Deng D, Xu F, Liu J, Li B, Li L, Liu J, Chen F (2020) Clinical application of pedicled thoracoacromial artery perforator flaps for tracheal reconstruction. BMC Surg 20(1):299. https://doi.org/10.1186/s12893-020-00972-9CrossRefPubMedPubMedCentral

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 11(1):23–27. https://doi.org/10.1177/229255030301100102CrossRefPubMedPubMedCentral

Goishi K, Harada H, Keyama T, Tsuda T, Hashimoto I (2020) Pectoralis major turnover flap based on thoracoacromial vessels for sternal dehiscence. Microsurgery 40(2):137–144. https://doi.org/10.1002/micr.30509CrossRefPubMed

Hallock GG (2011) The Island thoracoacromial artery muscle perforator flap. Ann Plast Surg 66(2):168–171. https://doi.org/10.1097/SAP.0b013e3181dc83cdCrossRefPubMed

Iida T, Yoshimatsu H (2019) Anatomical study and clinical application of free thoracoacromial artery true-perforator flap for reconstruction of the face. J Craniofac Surg 30(1):205–207. https://doi.org/10.1097/SCS.0000000000004968CrossRefPubMed

Li EN, Goldberg NH, Slezak S, Silverman RP (2004) Split pectoralis major flaps for mediastinal wound coverage: a 12 year experience. Ann Plast Surg 53(4):334–337. https://doi.org/10.1097/01.sap.0000120684.64559.49CrossRefPubMed

Loukas M, Louis RG, Almond J, Armstrong T (2005) A case of an anomalous radial artery arising from the thoracoacromial trunk. Surg Radiol Anat 27(5):463–466. https://doi.org/10.1007/s00276-005-0028-1CrossRefPubMed

Loukas M, du Plessis M, Owens DG, Kinsella CR, Litchfield CR, Nacar A, Lu O, Tubbs RS (2014) The lateral thoracic artery revisited. Surg Radiol Anat 36(6):543–549. https://doi.org/10.1007/s00276-013-1234-xCrossRefPubMed

Moore KL, Dalley AF, Agur A (2017) Clinically oriented anatomy, 8th edn. Lippincott Williams and Wilkins, Philadelphia

10.

Pandey SK, Shukla VK (2004) Anatomical variation in origin and course of the thoracoacromial trunk and its branches. Nepal Med Coll J 6(2):88–91PubMed

11.

Park H-D, Min Y-S, Kwak H-H, Youn K-H, Lee E-W, Kim H-J (2004) Anatomical study concerning the origin and course of the pectoral branch of the thoracoacromial trunk for the pectoralis major flap. Surg Radiol Anat 26(6):428–432. https://doi.org/10.1007/s00276-004-0273-8CrossRefPubMed

12.

Portenard A, Auquit-Auckbur I, Gardeil L, Elbaz B, Carricaburu A, Duparc F (2019) Anatomical study of the perforator flap based on the acromial branch of the thoraco-acromial artery (abTAA flap): a cadaveric study. Surg Radiol Anat 41(11):1361–1367. https://doi.org/10.1007/s00276-019-02322-8CrossRefPubMed

13.

Reid CD, Ian Taylor G (1984) The vascular territory of the acromiothoracic axis. Br J Plast Surg 37(2):194–212. https://doi.org/10.1016/0007-1226(84)90010-9CrossRefPubMed

14.

Song D, Pafitanis G, Pont LEP, Yang P, Koshima I, Zhang Y, Iida T, Zhou X, Li Z (2018) Chimeric thoracoacromial artery perforator flap for one-staged reconstruction of complex pharyngoesophageal defects: a single unit experience. Head Neck 40(2):302–311. https://doi.org/10.1002/hed.24962CrossRefPubMed

15.

Song D, Pafitanis G, Reissis D, Koshima I, Zhang Y, Narushima M, Zhou X, Li Z (2020) A sequential thoracoacromial artery perforator flap for reconstructing the donor site of sternocleidomastoid myocutaneous flaps. Ann Plast Surg 84(6):657–664. https://doi.org/10.1097/SAP.0000000000002042CrossRefPubMed

16.

Thalaivirithan Margabandu B, Dympep B, Jaganmohan JJ (2020) Perforator flaps based on the terminal perforators of the pectoral branch of thoracoacromial vessels axis. Ann Plast Surg 84(1):76–84. https://doi.org/10.1097/SAP.0000000000001952CrossRefPubMed

17.

Yamamoto T, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto N (2021) Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction. J Surg Oncol 123(5):1232–1237. https://doi.org/10.1002/jso.26421CrossRefPubMed

18.

Zhang YX, Yongjie H, Messmer C, Ong YS, Li Z, Zhou X, Spinelli G, Agostini T, Levin LS, Lazzeri D (2013) Thoracoacromial artery perforator flap. Plast Reconstr Surg 131(5):759e–770e. https://doi.org/10.1097/PRS.0b013e3182865bf5CrossRefPubMed

19.

Żytkowski A, Tubbs RS, Iwanaga J, Clarke E, Polguj M, Wysiadecki G (2021) Anatomical normality and variability: historical perspective and methodological considerations. Transl Res Anat 23:100105. https://doi.org/10.1016/j.tria.2020.100105CrossRef

Title: The thoracoacromial trunk: a detailed analysis
Authors: Michał Bonczar
Kamil Gabryszuk
Patryk Ostrowski
Jakub Batko
Daniel Jakub Rams
Agata Krawczyk-Ożóg
Wadim Wojciechowski
Jerzy Walocha
Mateusz Koziej
Publication date: 12-09-2022
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 10/2022
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-022-03016-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The thoracoacromial trunk: a detailed analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2022

Correction to: A rare bifurcation of the external iliac artery into femoral and deep femoral arteries

Replaced right hepatic artery arising from the distal renal artery, a new variation

A prevalence study of the atlantomastoid muscle

Anatomy of the nasal latero-lateral cartilage articulation: a micro-MRI study in human specimens

Oculomotor nerve root split: incidental finding on MRI—case report and literature review

The prevalence of the anatomical variation in a Turkish population: supernumerary muscle–anconeus epitrochlearis