Application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHANG Yixin ² , ZHOU Bo ¹ , LÜ Chunliu ¹ , TANG Yuanyuan ¹ , YI Liang ¹ , LUO Zhenhua ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P. R. China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P. R. China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Thoracodorsal vessel; anterior serratus branch; chest wall reconstruction; vascular anastomosis

DOI：

10.7507/1002-1892.202202002

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Objective To investigate the application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect. Methods Between October 2018 and March 2021, bilateral free lower abdominal flaps were used to repair large-area complex defects after chest wall tumor surgery in 23 patients. The patients were all female; the age ranged from 23 to 71 years, with an average age of 48.5 years. There were 11 cases of locally advanced breast cancer, 4 cases of phyllodes cell sarcoma, 3 cases of soft tissue sarcoma, 3 cases of recurrence of breast cancer, and 2 case of osteoradionecrosis. The size of secondary chest wall defect after tumor resection and wound debridement ranged from 20 cm×10 cm to 38 cm×14 cm, the size of flap ranged from 25 cm×12 cm to 38 cm×15 cm, the length of vascular pedicle was 9-12 cm (mean, 11.4 cm). Fourteen cases of simple soft tissue defects were repaired by flap transplantation; 5 cases of rib defects (<3 ribs) and soft tissue defects were repaired by simple mesh combined with flap transplantation; and 4 cases of full-thickness chest wall defect with large-scale rib defect (>3 ribs) were repaired by “mesh plus bone cement” rigid internal fixation combined with flap transplantation. The anterior serratus branch of thoracodorsal vessel was selected as the recipient vessel in all cases, the revascularization methods include 3 types: the proximal end of the anterior serratus branch plus other recipient vessels (13 cases), proximal and distal ends of anterior serratus branch (6 cases), and proximal ends of two anterior serratus branches (4 cases). Results The main trunk of thoracodorsal vessels was preserved completely in 23 patients. All patients were followed up 10-18 months, with an average of 13.9 months. After operation, the flap survived completely, the shape of reconstructed chest wall was good, the texture was satisfactory, and there was no flap contracture deformation. There was only a linear scar left in the flap donor site, and the abdominal wall function was not significantly affected. There was no tumor recurrence during follow-up. Conclusion The anterior serratus branch of thoracodorsal vessel has a constant anatomy and causes little damage to the recipient site, so it can provide reliable blood supply for free flap transplantation.

Citation： SONG Dajiang, LI Zan, ZHANG Yixin, ZHOU Bo, LÜ Chunliu, TANG Yuanyuan, YI Liang, LUO Zhenhua. Application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 1021-1025. doi: 10.7507/1002-1892.202202002 Copy

1.	李赞, 宋达疆. 肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响. 中华整形外科杂志, 2020, 36(3): 231-241.
2.	Song D, Li J, Pafitanis G, et al. Bilateral anterolateral thigh myocutaneous flaps for giant complex chest wall reconstruction. Ann Plast Surg, 2021, 87(3): 298-309.
3.	Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: A 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
4.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
5.	宋达疆, 李赞, 周晓, 等. 胸壁肿瘤术后胸壁复杂缺损修复重建策略. 中华胸心血管外科杂志, 2017, 33(3): 164-167.
6.	Banwell M, Trotter D, Ramakrishnan V. The thoracodorsal artery and vein as recipient vessels for microsurgical breast reconstruction. Ann Plast Surg, 2012, 68(5): 542-543.
7.	Moran SL, Nava G, Behnam AB, et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg, 2003, 111(6): 1876-1882.
8.	Saint-Cyr M, Chang DW, Robb GL, et al. Internal mammary perforator recipient vessels for breast reconstruction using free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg, 2007, 120(7): 1769-1773.
9.	Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg, 1999, 52(2): 104-111.
10.	宋达疆, 李赞, 周晓, 等. 同时携带肋间动脉穿支与腹壁下动脉穿支保留部分腹直肌的游离腹直肌皮瓣再造乳房. 中国修复重建外科杂志, 2021, 35(5): 605-610.
11.	Hamdi M, Blondeel P, Van Landuyt K, et al. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators. Br J Plast Surg, 2004, 57(3): 258-265.
12.	Mackey SP, Ramsey KW. Exploring the myth of the valveless internal mammary vein-a cadaveric study. J Plast Reconstr Aesthet Surg, 2011, 64(9): 1174-1179.
13.	Chavanon O, Romary B, Martin C, et al. Anatomical study of the internal thoracic arteries; implications for use in coronary artery bypass graft surgery. Surg Radiol Anat, 2016, 38(10): 1135-1142.
14.	Rozen WM, Ye X, Guio-Aguilar PL, et al. Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications. Breast Cancer Res Treat, 2012, 134(1): 181-198.
15.	Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
16.	Kim JT. Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps. Plast Reconstr Surg, 2005, 115(3): 755-763.

1. 李赞, 宋达疆. 肿瘤性复杂性胸壁缺损的修复策略及对肿瘤治疗的积极影响. 中华整形外科杂志, 2020, 36(3): 231-241.
2. Song D, Li J, Pafitanis G, et al. Bilateral anterolateral thigh myocutaneous flaps for giant complex chest wall reconstruction. Ann Plast Surg, 2021, 87(3): 298-309.
3. Song D, Liu D, Pafitanis G, et al. Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: A 10-year single-unit experience. Ann Plast Surg, 2020, 84(3): 293-299.
4. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
5. 宋达疆, 李赞, 周晓, 等. 胸壁肿瘤术后胸壁复杂缺损修复重建策略. 中华胸心血管外科杂志, 2017, 33(3): 164-167.
6. Banwell M, Trotter D, Ramakrishnan V. The thoracodorsal artery and vein as recipient vessels for microsurgical breast reconstruction. Ann Plast Surg, 2012, 68(5): 542-543.
7. Moran SL, Nava G, Behnam AB, et al. An outcome analysis comparing the thoracodorsal and internal mammary vessels as recipient sites for microvascular breast reconstruction: a prospective study of 100 patients. Plast Reconstr Surg, 2003, 111(6): 1876-1882.
8. Saint-Cyr M, Chang DW, Robb GL, et al. Internal mammary perforator recipient vessels for breast reconstruction using free TRAM, DIEP, and SIEA flaps. Plast Reconstr Surg, 2007, 120(7): 1769-1773.
9. Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg, 1999, 52(2): 104-111.
10. 宋达疆, 李赞, 周晓, 等. 同时携带肋间动脉穿支与腹壁下动脉穿支保留部分腹直肌的游离腹直肌皮瓣再造乳房. 中国修复重建外科杂志, 2021, 35(5): 605-610.
11. Hamdi M, Blondeel P, Van Landuyt K, et al. Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators. Br J Plast Surg, 2004, 57(3): 258-265.
12. Mackey SP, Ramsey KW. Exploring the myth of the valveless internal mammary vein-a cadaveric study. J Plast Reconstr Aesthet Surg, 2011, 64(9): 1174-1179.
13. Chavanon O, Romary B, Martin C, et al. Anatomical study of the internal thoracic arteries; implications for use in coronary artery bypass graft surgery. Surg Radiol Anat, 2016, 38(10): 1135-1142.
14. Rozen WM, Ye X, Guio-Aguilar PL, et al. Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications. Breast Cancer Res Treat, 2012, 134(1): 181-198.
15. Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
16. Kim JT. Two options for perforator flaps in the flank donor site: latissimus dorsi and thoracodorsal perforator flaps. Plast Reconstr Surg, 2005, 115(3): 755-763.

Chinese Journal of Reparative and Reconstructive Surgery

Application of anterior serratus branch of thoracodorsal vessel in repairing chest wall defect

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