Lymph Fasciocutaneous Lateral Thoracic Artery Flap: Anatomical Study and Clinical Use

Imagem de Miniatura
Arquivos
art_BARREIRO_Lymph_Fasciocutaneous_Lateral_Thoracic_Artery_Flap_Anatomical_Study_2014.PDF (384.64 KB)
Citações na Scopus
45
Tipo de produção
article
Data de publicação
2014
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
THIEME MEDICAL PUBL INC
Autores
BAPTISTA, Rachel Rossine
Citação
JOURNAL OF RECONSTRUCTIVE MICROSURGERY, v.30, n.6, p.389-396, 2014
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background The lateral thoracic flap was first studied in the mid-1970s but its use has been limited because of pedicle anatomical variations. However, after the development of lymph node transfer surgery, the axilla/upper lateral thorax presented as a promising donor area. Through a detailed anatomical study, the lateral thoracic flap was evaluated regarding its vascularization and composition. Later, it was used for pedicle and free flap reconstructions. Methods A total of 40 flaps were dissected in fresh cadavers and the characteristics of the lateral thoracic pedicle and its relationship to the upper lateral thoracic axillary lymph nodes (LTLN) were analyzed. We performed six pedicle flap reconstructions around the shoulder area and a free lymph node transfer for lower limb lymphedema. Results In the cadaveric dissections, the lateral thoracic pedicle branched off the axillary vessels and was found to be a primary level I axillary lymph node irrigator before reaching the skin. The cutaneous portion of the artery was present in 87.5% of the dissections. Arterial caliber was an average of 1.3 and venous, 2.6 mm. Five to seven lymph nodes were isolated with each pedicle and a lymph fasciocutaneous flap could be designed. In seven clinical cases, all of the flaps survived. Functioning lymph nodes were visualized on lymphoscintigraphy after their transfer to the ankle. Donor area had an inconspicuous evolution. Conclusion Lateral thoracic flap is a feasible flap with low donor area morbidity in a concealed region that can be harvested with upper LTLN for transplantation.
Palavras-chave
lateral thoracic flap, lymph fasciocutaneous flap, lateral thoracic artery, lymph node transfer, lymphedema
URI
https://observatorio.fm.usp.br/handle/OPI/7309
Referências
  1. ANGRIGIANI C, 1995, PLAST RECONSTR SURG, V96, P1608, DOI 10.1097/00006534-199512000-00014
  2. Badger C, 2004, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD003141.PUB2
  3. BAKER SR, 1981, ARCH OTOLARYNGOL, V107, P409
  4. BAUDET J, 1976, PLAST RECONSTR SURG, V58, P680, DOI 10.1097/00006534-197612000-00005
  5. BHATTACHARYA S, 1990, BRIT J PLAST SURG, V43, P162, DOI 10.1016/0007-1226(90)90156-T
  6. Casabona F, 2009, ANN SURG ONCOL, V16, P2459, DOI 10.1245/s10434-009-0554-x
  7. Chan YW, 2009, J PLAST RECONSTR AES, V62, P1004, DOI 10.1016/j.bjps.2008.02.009
  8. Connor C, 2013, ANN SURG ONCOL, V20, P3303, DOI 10.1245/s10434-013-3113-4
  9. Dayan JH, 2014, J RECONSTR MICROSURG, V30, P41, DOI 10.1055/s-0033-1351668
  10. de Coninck A, 1976, CHIR PLAST BERLIN, V3, P283
  11. Hamdi M, 2010, CLIN PLAST SURG, V37, P655, DOI 10.1016/j.cps.2010.06.004
  12. HARII K, 1978, PLAST RECONSTR SURG, V62, P212, DOI 10.1097/00006534-197808000-00009
  13. Heitmann C, 2003, ANN PLAS SURG, V51, P23, DOI 10.1097/01.SAP.0000054189.14799.F3
  14. Honkonen KM, 2013, ANN SURG, V257, P961, DOI 10.1097/SLA.0b013e31826ed043
  15. International Society of Lymphology, 2013, LYMPHOLOGY, V46, P1
  16. IRIGARAY A, 1979, PLAST RECONSTR SURG, V64, P259, DOI 10.1097/00006534-197908000-00032
  17. Kim JT, 2005, PLAST RECONSTR SURG, V115, P755, DOI 10.1097/01.PRS.0000152427.09893.80
  18. Kim JT, 2011, J PLAST RECONSTR AES, V64, P902, DOI 10.1016/j.bjps.2010.11.027
  19. Kim JT, 2011, J PLAST RECONSTR AES, V64, P1596, DOI 10.1016/j.bjps.2011.06.048
  20. Lin CH, 2009, PLAST RECONSTR SURG, V123, P1265, DOI 10.1097/PRS.0b013e31819e6529
  21. Partsch H, 2008, INT ANGIOL, V27, P193
  22. ROWSELL AR, 1984, BRIT J PLAST SURG, V37, P574, DOI 10.1016/0007-1226(84)90152-8
  23. Schaverien M, 2010, J PLAST RECONSTR AES, V63, P2123, DOI 10.1016/j.bjps.2009.12.020
  24. Schwabegger AH, 2000, BRIT J PLAST SURG, V53, P676, DOI 10.1054/bjps.2000.3443
  25. Shi J, 2013, J PLAST RECONSTR AES, V66, P1369, DOI 10.1016/j.bjps.2013.05.032
  26. Spinelli HM, 1996, ANN PLAS SURG, V37, P500, DOI 10.1097/00000637-199611000-00008
  27. Suami H, 2008, PLAST RECONSTR SURG, V121, P1231, DOI 10.1097/01.prs.0000302511.21140.36
  28. TAYLOR GI, 1975, PLAST RECONSTR SURG, V56, P243, DOI 10.1097/00006534-197509000-00001
  29. Teo Wan-Lin, 2012, Arch Plast Surg, V39, P663, DOI 10.5999/aps.2012.39.6.663
  30. Thomas BP, 2005, PLAST RECONSTR SURG, V116, P818, DOI 10.1097/01.prs.0000176253.42394.7c
  31. Thompson M, 2007, ANN SURG ONCOL, V14, P1890, DOI 10.1245/s10434-007-9412-x
  32. Tseng CY, 2010, CLIN PLAST SURG, V37, P641, DOI 10.1016/j.cps.2010.06.002
  33. Xie F, 2013, BURNS, V39, P1257, DOI 10.1016/j.burns.2013.01.003
  34. Ying L, 1983, ACTA ANATOMICA SINIC, V14, P23
  35. Yuen APW, 2007, LARYNGOSCOPE, V117, P288, DOI 10.1097/01.mlg.0000250494.62826.6b

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/04