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J Reconstr Microsurg 2022; 38(09): 683-693
DOI: 10.1055/s-0042-1743168
Original Article

An Anatomical Study of Posterior Trunk Recipient Vessels, and Comparisons of Outcome following Pedicled- and Free-Flap Transfers for Treatment of Sarcoma in the Posterior Trunk

Ryo Karakawa 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
2   Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
,
Hidehiko Yoshimatsu
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
2   Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
,
Keisuke Kamiya
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
,
Yuma Fuse 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
,
Tomoyuki Yano 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
2   Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
,
Satoru Muro
2   Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
,
Keiichi Akita
2   Department of Clinical Anatomy, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Tokyo, Japan
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Abstract

Background Reconstruction after wide resection of a large sarcoma arising in the posterior trunk may require free-flap transfer to reduce the postoperative complications. Here, we describe the recipient vessels on the whole posterior trunk. Moreover, to show the reliability of these vessels, we describe an institutional series of free-flap reconstruction.

Methods In the cadaveric study, 20 posterior trunk regions from 10 fixed cadavers were dissected. The location and the diameter of the perforating artery and vein on the posterior were documented. In the clinical study, 54 patients undergoing immediate reconstruction surgery with only a pedicled flap (n = 45) and with a free flap (n = 9) after sarcoma resection on the posterior trunk between July 2005 and September 2021 were identified. One-to-one propensity score matching was performed to compare the postoperative complications.

Results In the cadaveric study, a total of 178 perforators were identified. The average diameter of the superficial cervical artery (SCA) and vein, dorsal scapular artery (DSA) and vein, medial branch of dorsal intercostal artery perforator (m-DICAP) and vein, lateral branch of dorsal intercostal artery perforator (l-DICAP) and vein, and dorsolateral intercostal artery perforator (DLICAP) and vein were 1.03, 1.67, 1.38, 1.84, 1.28, 1.84, 1.01, 1.60, 1.11, and 1.70 mm. In the clinical study, the propensity score-matched analysis involving eight pairs showed a significantly higher occurrence of total complications in the pedicled-flap group than the free-flap group (62.5 vs. 0%, p = 0.03).

Conclusion The cadaveric study showed that the perforators from the SCA, DSA, and posterior intercostal artery are constantly present. The clinical study demonstrated the feasibility and reliability of a free-flap transfer.

Keywords

sarcoma - trunk - reconstruction - PAP flap

Financial Disclosure

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.


Supplementary Material



Publication History

Received: 04 October 2021

Accepted: 27 December 2021

Article published online:
10 March 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988; 81 (04) 561-566
    CrossrefPubMedGoogle Scholar
  • 2 Casas LA, Lewis Jr VL. A reliable approach to the closure of large acquired midline defects of the back. Plast Reconstr Surg 1989; 84 (04) 632-641
    CrossrefPubMedGoogle Scholar
  • 3 Evans GR, Reece GP. Lower back reconstruction: an approach to wound closure in the cancer patient. Plast Reconstr Surg 1995; 96 (03) 635-642
    CrossrefPubMedGoogle Scholar
  • 4 McCraw JB, Penix JO, Baker JW. Repair of major defects of the chest wall and spine with the latissimus dorsi myocutaneous flap. Plast Reconstr Surg 1978; 62 (02) 197-206
    CrossrefPubMedGoogle Scholar
  • 5 Scheflan M, Mehrhof Jr AI, Ward JD. Meningomyelocele closure with distally based latissimus dorsi flap. Plast Reconstr Surg 1984; 73 (06) 956-959
    CrossrefPubMedGoogle Scholar
  • 6 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    CrossrefPubMedGoogle Scholar
  • 7 Brunetti B, Tenna S, Aveta A. et al. Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: clinical experience on 20 consecutive oncological cases. Microsurgery 2016; 36 (07) 546-551
    CrossrefPubMedGoogle Scholar
  • 8 Prasad V, Almutairi K, Kimble FW, Stewart F, Morris SF. Dorsolateral musculocutaneous perforators of posterior intercostal artery: an anatomical study. J Plast Reconstr Aesthet Surg 2012; 65 (11) 1518-1524
    CrossrefPubMedGoogle Scholar
  • 9 Minabe T, Harii K. Dorsal intercostal artery perforator flap: anatomical study and clinical applications. Plast Reconstr Surg 2007; 120 (03) 681-689
    CrossrefPubMedGoogle Scholar
  • 10 Ogawa R, Hyakusoku H, Murakami M, Aoki R, Tanuma K, Pennington DG. An anatomical and clinical study of the dorsal intercostal cutaneous perforators, and application to free microvascular augmented subdermal vascular network (ma-SVN) flaps. Br J Plast Surg 2002; 55 (05) 396-401
    CrossrefPubMedGoogle Scholar
  • 11 de Weerd L, Weum S. The sensate medial dorsal intercostal artery perforator flap for closure of cervicothoracic midline defects after spinal surgery: an anatomic study and case reports. Ann Plast Surg 2009; 63 (04) 418-421
    CrossrefPubMedGoogle Scholar
  • 12 Lee YJ, Baek SE, Lee J, Oh DY, Rhie JW, Moon SH. Perforating vessel as an alternative option of a recipient selection for posterior trunk-free flap reconstruction. Microsurgery 2018; 38 (07) 763-771
    CrossrefPubMedGoogle Scholar
  • 13 Mathes DW, Thornton JF, Rohrich RJ. Management of posterior trunk defects. Plast Reconstr Surg 2006; 118 (03) 73e-83e
    CrossrefPubMedGoogle Scholar
  • 14 Kim JT. Latissimus dorsi perforator flap. Clin Plast Surg 2003; 30 (03) 403-431
    CrossrefPubMedGoogle Scholar
  • 15 Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg 1978; 61 (05) 653-665
    CrossrefPubMedGoogle Scholar
  • 16 Aho JM, Laungani AT, Herbig KS, Wong C, Kirchoff RW, Saint-Cyr M. Lumbar and thoracic perforators: vascular anatomy and clinical implications. Plast Reconstr Surg 2014; 134 (04) 635e-645e
    CrossrefPubMedGoogle Scholar
  • 17 Prasad V, Morris SF. Propeller DICAP flap for a large defect on the back-case report and review of the literature. Microsurgery 2012; 32 (08) 617-621
    CrossrefPubMedGoogle Scholar
  • 18 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46 (03) 399-424
    CrossrefPubMedGoogle Scholar
  • 19 Haas F, Weiglein A, Schwarzl F, Scharnagl E. The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery. Plast Reconstr Surg 2004; 113 (06) 1580-1590
    CrossrefPubMedGoogle Scholar
  • 20 Seo BF, Choi JY, Han HH. et al. Perforators as recipients for free flap reconstruction of the inguinal and perineal region. Microsurgery 2015; 35 (08) 627-633
    CrossrefPubMedGoogle Scholar
  • 21 Oh TS, Hallock G, Hong JP. Freestyle propeller flaps to reconstruct defects of the posterior trunk: a simple approach to a difficult problem. Ann Plast Surg 2012; 68 (01) 79-82
    CrossrefPubMedGoogle Scholar
  • 22 Yoshimatsu H, Karakawa R, Scaglioni MF, Fuse Y, Tanakura K, Yano T. Application of intraoperative indocyanine green angiography for detecting flap congestion in the use of free deep inferior epigastric perforator flaps for breast reconstruction. Microsurgery 2021; 41 (06) 522-526
    CrossrefPubMedGoogle Scholar
  • 23 Karakawa R, Yoshimatsu H, Tanakura K. et al. An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography. J Plast Reconstr Aesthet Surg 2020; 73 (09) 1768-1774
    CrossrefPubMedGoogle Scholar
  • 24 Karakawa R, Yoshimatsu H, Fuse Y. et al. The correlation of the perforators and the accessory saphenous vein in a profunda femoris artery perforator flap for additional venous anastomosis: a cadaveric study and clinical application. Microsurgery 2020; 40 (02) 200-206
    CrossrefPubMedGoogle Scholar
  • 25 Karakawa R, Yoshimatsu H, Maeda E. et al. Use of the profunda femoris artery perforator flap for reconstruction after sarcoma resection. Plast Reconstr Surg Glob Open 2020; 8 (12) e3289
    CrossrefPubMedGoogle Scholar
  • 26 Yoshimatsu H, Karakawa R, Fuse Y. et al. Use of the superficial circumflex iliac artery perforator flap for reconstruction after sarcoma resection. J Surg Oncol 2021; 123 (04) 1067-1080
    CrossrefPubMedGoogle Scholar