The thoracoacromial vessels as recipient vessels in microsurgery and supermicrosurgery: an anatomical and sonographic study

The purpose of this study was to investigate the presence and the precise course of the pectoral branch of the thoracoacromial vessels on the underside of the pectoralis major muscle by anatomical dissection and by color Doppler ultrasound. A further goal was to determine whether these vessels were suitable as recipient vessels in microsurgery and supermicrosurgery for breast reconstruction. In 18 cadavers, the pectoral branch of the thoracoacromial vessels was followed caudally until the diameter of the artery diminished to 1 mm. The same examination was carried out in 40 young female volunteers by tracing the vessel course with color Doppler ultrasound. The 1-mm cutoff point of the artery was measured with reference to the manubrium, the midsternal line, the clavicle, and the upper border of the closest rib. In addition, in the cadavers, the 2-mm cutoff point was determined. At both cutoff points, the diameter of the accompanying vein was measured. The pectoral branch of the thoracoacromial vessels with the artery and concomitant veins could be detected on all 100 undersides of the pectoralis major muscle, anatomically and sonographically. In their course from the acromial region downward, the arteries reached a diameter of 1 mm at an average of 9.9 cm from the manubrium, horizontally 9.4 cm from the midsternal line, and vertically 4.0 cm from the lower border of the clavicle. The 1-mm reference point was situated on the upper border of the third rib in 85 percent of cases. The average distance between the 1-mm and the 2-mm cutoff points was 3.5 cm. At the 1-mm cutoff point, the diameter of the vein was 0.9 mm, and at the 2-mm cutoff point, it was 1.7 mm. Because of their central position at the anterior hemithorax, these vessels are easily accessible from mastectomy incisions, even in skin-sparing mastectomies; the donor-site morbidity is negligible; and as the diameters of the vessels gradually decrease along their caudal course, the recipient site can be chosen precisely according to the length and the diameter of the donor vessels and major mismatch can be avoided. Thus, the pectoral branches of the thoracoacromial vessels are well suited as recipient vessels for (super)microsurgery and are a very promising addendum to the thoracodorsal and internal mammary vessels.