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Back to 2014 Annual Meeting Abstracts
Transverse Infraclavicular Thoracoacromial (TIC TAC): A New Approach to a Rarely Used Recipient in Microsurgical Breast Reconstruction
Devinder P. Singh, MD, Jeffrey Zapora, MD, Luther Hamilton Holton, III, MD, Susan Kesmodel, MD, Alexander F. Au, MD, Jens Berli, MD, Owen Johnson, MD, Vasilios D. Mavrophilipos, BA, John Maddox, MD, E. Bryan Buckingham, MD, Karan Chopra, MD, Lindsay James, BA, Rachel Bluebond-Langner, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
BACKGROUND:
The internal mammary (IM) vessels and thoracodorsal (TD) vessels are the most commonly used recipients for microvascular breast reconstruction. However, these vessels are sometimes unavailable or compromised recipients. This study demonstrates that a transverse infraclavicular (TIC) incision can provide ideal exposure to quickly, safely, and reliably perform the anastomosis of a free flap to the thoracoacromial (TAC) vessels for breast reconstruction.
METHODS:
One fresh cadaver torso was used to demonstrate the feasibility of harvesting and delivering the thoracoacromial vessels through a transverse infraclavicular incision. We also report a bilateral MS-TRAM to TIC TAC vessels for delayed breast reconstruction in a non-irradiated 47 year old patient with a history of tissue expanders explanted for infection.
RESULTS:
Review of the literature revealed five descriptions of the thoracoacromial vessels used in breast reconstruction; in two cases as a primary recipient, in two cases for supercharging, and in one case for a free latissimus flap to treat a complication of prior autologous reconstruction. The cadaver dissection demonstrated an average pedicle length of 5.25 cm and diameter of 3.75 mm for the artery and vein combined. In the cadaver dissection, the pedicle was prepared in 10 minutes on one side and in 13 minutes on the other side. In the case reported, the pedicle was isolated and delivered through an infraclavicular incision in 16 minutes on one side and in 12 minutes on the other side.
CONCLUSIONS:
Based on our review of the literature, a transverse infraclavicular approach to the thoracoacromial vessels has never been described. With our cadaver dissection and our clinical case we have shown that this approach is feasible and may be beneficial in previously irradiated patients and in patients at high risk for coronary artery disease who may benefit from a CABG in the future. This approach can significantly reduce the operative time spent preparing the recipient vessels and can be used as an alternative option in the case of thrombosis or flap failure.
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