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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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