The Circumflex Scapular Vessels Are Reliable Recipient Vessels for Abdominal-Based Breast Reconstruction
Osama Samargandi, MD, MHSc, FRCSC1; Williamson J Scott, MD, FRCS(C), FACS2
1King Abdulaziz University Hospital, Jeddah, Saudi Arabia, 2Kelowna Plastic Surgeons, Kelowna, BC, Canada
Background: Reports on the use of the circumflex scapular vessels (CSV) as recipient pedicle for autologous breast reconstruction are scarce. We report our technique and experience of using the CSV as our primary recipient vessels to abdominal based free flaps.
Methods: The axillary system was used in a total of 220 free flaps from 2000-2021. The CSV were used as recipient vessels in 103 (47%) and the thoracodorsal vessels (TDV) were used in 116 (53%). The approach is performed while patients in supine position with arm in abducted position. After retracting the anterior border of the latissimus dorsi muscle, the teres major muscle is marked to identify the triangular space where the CSV are identified (video technique is available).
Results: Only one flap failed while using the CSV and three flaps failed when the TDV were used. Conversion from CSV to TDV was done in only one case. The CSV typically consist of an artery and 2 vena comitantes. However, one dominant vein was observed in 18 cases The size of the vessels consistently ranged from 1.5mm to 3mm with excellent size match with the deep inferior epigastric vessels. The length of the CSV pedicle ranged from 6-7 cm. The vessels were readily accessible in cases needed axillary lymph node dissection. The vessels were also spared from surgical and radiation injury in all cases.
Conclusion: The use of CSV as recipient vessels for abdominal-based free flap in breast reconstruction is feasible and reliable. This technique avoids the sacrifice of the TDV and avoid the need to disrupt flap inset during re-exploration. It can be used primarily or as a reliable backup option in case of unusable internal mammary vessels.
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