Thomas F Barrett1, Hilary Orlowski2, Jason Rich1, Ryan S Jackson1, Patrik Pipkorn3, Sidharth V Puram4. 1. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, MO, USA. 2. Department of Radiology, Washington University School of Medicine in St. Louis, MO, USA. 3. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, MO, USA. Electronic address: ppipkorn@wustl.edu. 4. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, MO, USA; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: sidpuram@wustl.edu.
Abstract
BACKGROUND: Composite flaps based on the subscapular arterial system are excellent choices for complex defects, including those of the head and neck, though rates of anatomic variants are not well described. OBJECTIVE: Characterize subscapular-thoracodorsal arterial system in a large cohort of patients using CT chest angiography. METHODS: CTA chest studies from 100 adult patients were analyzed to characterize the bilateral subscapular-thoracodorsal arterial systems. RESULTS: Out of 200 arterial systems, 25 (12.5%) were lacking a subscapular artery, with the thoracodoral and circumflex scapular arteries arising independently off of the axillary (or other nearby vessels). Strikingly, the subscapular artery was absent bilaterally in 5 patients and absent unilaterally in 15 patients, meaning that one in five patients harbored abnormal anatomy on at least one side. There was no radiographic evidence of atherosclerosis in the studied vessels in any patient, including smokers and patients with atherosclerosis in other vessels. CONCLUSION: Variations in the subscapular-thoracodorsal arterial system appear more frequent than previously described. For select patients requiring complex reconstruction using the scapular system, CTA chest may aide surgical planning.
BACKGROUND: Composite flaps based on the subscapular arterial system are excellent choices for complex defects, including those of the head and neck, though rates of anatomic variants are not well described. OBJECTIVE: Characterize subscapular-thoracodorsal arterial system in a large cohort of patients using CT chest angiography. METHODS: CTA chest studies from 100 adult patients were analyzed to characterize the bilateral subscapular-thoracodorsal arterial systems. RESULTS: Out of 200 arterial systems, 25 (12.5%) were lacking a subscapular artery, with the thoracodoral and circumflex scapular arteries arising independently off of the axillary (or other nearby vessels). Strikingly, the subscapular artery was absent bilaterally in 5 patients and absent unilaterally in 15 patients, meaning that one in five patients harbored abnormal anatomy on at least one side. There was no radiographic evidence of atherosclerosis in the studied vessels in any patient, including smokers and patients with atherosclerosis in other vessels. CONCLUSION: Variations in the subscapular-thoracodorsal arterial system appear more frequent than previously described. For select patients requiring complex reconstruction using the scapular system, CTA chest may aide surgical planning.
Authors: Martin Lhuaire; Mikael Hivelin; Mohamed Derder; Vincent Hunsinger; Vincent Delmas; Peter Abrahams; Daniele Sommacale; Reza Kianmanesh; Christian Fontaine; Laurent Lantieri Journal: Surg Radiol Anat Date: 2018-12-13 Impact factor: 1.246
Authors: Rebecca W Gao; Brian A Nuyen; Vasu Divi; Davud Sirjani; Eben L Rosenthal Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-08-01 Impact factor: 6.223