A Study of Internal Thoracic Arteriovenous Principal Perforators by Using Multi-detector Row Computed Tomography Angiography

There are numerous reports on vessels involved in perforating branches running from the intercostal spaces of internal thoracic arteries and veins, and they have long been the subject of anatomical studies, partially because they provide pedicles for deltopectoral skin flaps.1-10 In addition, recent reports described their usefulness as recipient blood vessels in breast reconstruction using free skin flaps.11-16 According to past studies, perforating branches from each of the intercostal spaces have different diameters; those with large diameters are referred to as principal perforators, and opinions differ widely as to their locations.4 However, it is often reported that principal perforators are frequently found in the second or third intercostal space.1,3,12,17,18 Recently, there has been significant progress in imaging-based diagnosis, and the advent of multi-detector row computed tomography (MDCT) has allowed detailed 3-dimensional imaging of artery dissection at the perforating branch level. Multiple studies report its usefulness in preoperative testing for perforator flap surgery in the plastic and reconstructive surgery field.19-22 Preoperative contrast-enhanced MDCT also allows close examination of the inferior epigastric artery before breast reconstruction with free lower abdominal skin flaps. Close examination is performed while scanning the main branches of the internal thoracic arteries and veins serving as recipient blood vessels, as well as their perforating branches. In several cases, we have observed perforating branches that could be called principal perforators for both arteries and veins in the first intercostal space, which is not said to be their usual location. Here, we report different results from those in past studies that were obtained through close examination of recent MDCT data to determine the positions of principal perforators.