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J Reconstr Microsurg
DOI: 10.1055/s-0044-1787774
Original Article

The Arterial System of the Fasciocutaneous Deltoid Flap Pedicle on 320-Detector Row Computed Tomography and Clinical Application in the Foot and Hand

Nguyen Ngoc-Huyen 
1   Department of Upper Extremity Surgery and Microsurgery, Institute of Traumatology, Orthopedics and Plastic Surgery, Central Hospital 108, Hanoi, Vietnam
,
Nguyen The-Hoang 
1   Department of Upper Extremity Surgery and Microsurgery, Institute of Traumatology, Orthopedics and Plastic Surgery, Central Hospital 108, Hanoi, Vietnam
,
Khanh Lam 
2   Department of Diagnosis Imaging, Central Hospital 108, Hanoi, Vietnam
,
Nguyen Quang-Vinh
1   Department of Upper Extremity Surgery and Microsurgery, Institute of Traumatology, Orthopedics and Plastic Surgery, Central Hospital 108, Hanoi, Vietnam
,
Rainer Staudenmaier
3   Department of Plastic and Reconstructive Surgery, Technical University of Munich, Munich, Germany
› Author Affiliations Funding None.
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Abstract

Background Fasciocutaneous free deltoid flaps are used to reconstruct hand, foot, and maxillofacial defects. Although anatomical studies of this flap pedicle have been performed on cadavers, there are no reports on the use of 320-detector row computed tomography angiography (CTA-320) to investigate the deltoid flap pedicle in living humans. This study aimed to investigate the arterial characteristics of the deltoid flap pedicle using the CTA-320 system in living humans.

Methods Twenty-seven adult Vietnamese patients with 54 healthy deltoid regions underwent CTA-320 to investigate arterial blood supply before clinical free-flap transfer. Two- and three-dimensional reconstruction images of the arterial pedicle were visualized, and clinical reconstruction results were evaluated.

Results The cutaneous vessel branches of the deltoid flap were separated from the posterior circumflex humeral artery (PCHA) and originated from the axillary (77.78%), subscapular (12.96%), and brachial (9.26%) arteries. The PCHA penetrated the quadrangular space in 90.74% of patients. The cutaneous arterial branch was present in the deltoid-triceps groove in 100% of patients. The average diameter and length of the PCHA were 3.38 ± 0.58 and 43.08 ± 6.60 mm, respectively. The average diameter and length of the flap cutaneous branch were 1.49 ± 0.28 and 44.57 ± 4.83 mm, respectively. The findings of CTA-320 were aligned with the intraoperative clinical findings well. All deltoid flaps were successfully free-transferred with good outcomes.

Conclusion The CTA-320 is a practical and effective method for investigating deltoid flap pedicles. It enables accurate flap design and harvesting of flaps, thereby enhancing the clinical success of free-flap transfer.

Keywords

deltoid flap pedicle - CTA-320 method - free-flap transfer - soft tissue defect reconstruction

Data Availability Statement

The authors confirm that the data supporting the findings of this study are available within the article.




Publication History

Received: 20 February 2024

Accepted: 05 May 2024

Article published online:
24 June 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Franklin JD. The deltoid flap: anatomy and clinical applications. In: Buncke HJ, Furnas DW. eds. Symposium on Clinical Frontiers in Reconstructive Microsurgery; vol 24. St Louis, MO:: Mosby; 1984
    Google Scholar
  • 2 Meltem A, Metin G, Zeynep A, Cenk M, Betul UG. The free deltoid flap: clinical applications to upper extremity, lower extremity, and maxillary defects. Microsurgery 2007; 27 (05) 420-424
    CrossrefPubMedGoogle Scholar
  • 3 Russell RC, Guy RJ, Zook EG, Merrell JC. Extremity reconstruction using the free deltoid flap. Plast Reconstr Surg 1985; 76 (04) 586-595
    CrossrefPubMedGoogle Scholar
  • 4 Hahn SB, Kim NH, Yang IH. Deltoid sensory flap. J Reconstr Microsurg 1990; 6 (01) 21-27
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Wang Z, Sano K, Inokuchi T. et al. The free deltoid flap: microscopic anatomy studies and clinical application to oral cavity reconstruction. Plast Reconstr Surg 2003; 112 (02) 404-411
    CrossrefPubMedGoogle Scholar
  • 6 Strauch B, Yu HL, Chen ZW, Liebling R. Atlas of Microvascular Surgery: Anatomy and Operative Approaches. New York:: Thieme Medical Publishers, Inc;; 1993
    Google Scholar
  • 7 Halmy C, Szetei K, Nádai Z. et al. [Posterior circumflex humeral artery perforator flap (PCHAP-flap) in axillary scar release]. Orv Hetil 2009; 150 (13) 603-606
    CrossrefPubMedGoogle Scholar
  • 8 Otsuki Y, Nuri T, Okada M. et al. Axillary reconstruction with a posterior circumflex humeral artery perforator flap as a salvage surgery for axillary invasion of advanced breast cancer. Plast Reconstr Surg Glob Open 2018; 6 (09) e1920
    CrossrefPubMedGoogle Scholar
  • 9 Garieri P, Gatto A, Brambilla L, Cavalli E, Codazzi D, Marchesi A. Posterior circumflex humeral artery perforator flap: a cadaveric study and case series. Ann Plast Surg 2023; 90 (05) 447-450
    CrossrefPubMedGoogle Scholar
  • 10 Franklin JD, Goldstein RD. Free deltoid skin flap. In: Strauch B, Vasconez LO. eds. Grabb's Encyclopedia of Flaps-Upper Extremities, Torso, Pelvis, and Lower Extremities. 4th ed; vol 2. Lippincott Williams & Wilkins/Wolters Kluwer;; 2015: 858-862
    Google Scholar
  • 11 Edizer M, Tayfur V, Magden AO. et al. Anatomy of deltoid flap based on posterior subcutaneous deltoid artery: a cadaveric investigation. Int J Morphol 2014; 32: 404-408
    CrossrefPubMedGoogle Scholar
  • 12 Talbot NC, D'Antoni JV, Soileau LG, Storey NR, Fakoya A. Unusual origin of the posterior circumflex humeral artery: a case report. Cureus 2023; 15 (03) e36316
    PubMedGoogle Scholar
  • 13 Singh R. Abnormal origin of posterior circumflex humeral artery and subscapular artery: case report and review of the literature. J Vasc Bras 2017; 16 (03) 248-251
    CrossrefPubMedGoogle Scholar
  • 14 Cavdar S, Zeybek A, Bayramiçli M. Rare variation of the axillary artery. Clin Anat 2000; 13 (01) 66-68
    CrossrefPubMedGoogle Scholar
  • 15 Olinger A, Benninger B. Branching patterns of the lateral thoracic, subscapular, and posterior circumflex humeral arteries and their relationship to the posterior cord of the brachial plexus. Clin Anat 2010; 23 (04) 407-412
    CrossrefPubMedGoogle Scholar
  • 16 Mohandas Rao KG, Somayaji SN, Ashwini LS. et al. Variant course of posterior circumflex humeral artery associated with the abnormal origin of radial collateral artery: could it mimic the quadrangular space syndrome?. Acta Med Iran 2012; 50 (08) 572-576
    PubMedGoogle Scholar
  • 17 Baral P, Vijayabhaskar P, Roy S, Kumar S, Ghimire S, Shrestha U. Multiple arterial anomalies in upper limb. Kathmandu Univ Med J 2009; 7 (27) 293-297
    PubMedGoogle Scholar
  • 18 Sharma T, Singla RK, Sachdeva K. Bilateral superficial brachial artery. Kathmandu Univ Med J 2009; 7 (28) 426-428
    PubMedGoogle Scholar
  • 19 Cho HG, Kang B, Ryu JY. et al. Anatomical view of thoracodorsal artery variants using computed tomography angiography. J Reconstr Microsurg 2023; 39 (08) 640-647
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Nassar AH, Maselli AM, Manstein S. et al. Comparison of various modalities utilized for preoperative planning in microsurgical reconstructive surgery. J Reconstr Microsurg 2022; 38 (03) 170-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Higueras Suñé MC, López Ojeda A, Narváez García JA. et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg 2011; 64 (09) 1207-1213
    CrossrefPubMedGoogle Scholar
  • 22 Bhattacharya V, Agrawal NK, Chaudhary GR, Arvind S, Bhattacharya S. CT angiographic evaluation of perforators in the lower limb and their reconstructive implication. Indian J Plast Surg 2012; 45 (03) 494-497
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Rozen WM, Anavekar NS, Ashton MW. et al. Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?. Microsurgery 2008; 28 (07) 516-523
    CrossrefPubMedGoogle Scholar
  • 24 Rozen WM, Ashton MW, Stella DL. et al. Developments in perforator imaging for the anterolateral thigh flap: CT angiography and CT-guided stereotaxy. Microsurgery 2008; 28 (04) 227-232
    CrossrefPubMedGoogle Scholar
  • 25 Rozen WM, Ashton MW, Pan WR. et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29 (01) 16-23
    CrossrefPubMedGoogle Scholar
  • 26 Ribuffo D, Atzeni M, Saba L. et al. Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Surg Radiol Anat 2010; 32 (04) 329-334
    CrossrefPubMedGoogle Scholar
  • 27 Gacto-Sánchez P, Sicilia-Castro D, Gómez-Cía T. et al. Computed tomographic angiography with VirSSPA three-dimensional software for perforator navigation improves perioperative outcomes in DIEP flap breast reconstruction. Plast Reconstr Surg 2010; 125 (01) 24-31
    CrossrefPubMedGoogle Scholar
  • 28 Garvey PB, Chang EI, Selber JC. et al. A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteocutaneous flaps for head and neck reconstruction. Plast Reconstr Surg 2012; 130 (04) 541e-549e
    CrossrefPubMedGoogle Scholar
  • 29 Nguyen VT, Lam K, Le VD. Using 320-detector row computed tomography angiography to investigate the arterial anatomy of the toe flaps on living humans. Surg Radiol Anat 2021; 43 (10) 1711-1719
    CrossrefPubMedGoogle Scholar