Anatomical evaluation of the internal mammary vessels based on magnetic resonance imaging (MRI).
BACKGROUND
The rib-sparing technique to access the internal mammary vessels for microanastomosis is the current practice in our hospital nowadays. This study is performed to analyse the best intercostal space to expose those vessels.


METHODS
Magnetic resonance imaging (MRI) of the chest wall of 133 women was evaluated. The Schwabegger classification (representing the anatomical variation), the intercostal space between ribs two, three and four, and the surface of the internal mammary artery and veins in the second and third intercostal space were determined on multiplanar reconstructed T2-weighted images.


RESULTS
In more than half of the cases, the anatomy followed Schwabegger variation two; one lateral artery and one medial vein were symmetrical. If a second vein was present, the bifurcation was most commonly in the third intercostal space. The second intercostal space above the mammary vessels was significantly wider than the third one. The surface of the artery and vein(s) was significantly larger in the second intercostal space.


CONCLUSIONS
In most clinical situations, the second intercostal space is most likely the best approach to the internal mammary vessels for microanastomosis using a rib-sparing technique because of wider intercostal space and larger artery and vein.
Department of Plastic Surgery, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6202AZ Maastricht, The Netherlands. nervofaciale@yahoo.it
Stefania
S
Tuinder
Rieky
R
Dikmans
Robert-Jan
RJ
Schipper
Marc
M
Lobbes
Carla
C
Boetes
Wouter
W
Peeters
René
R
Van Der Hulst
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000098:blood supply; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008323:Mammary Arteries / Q000033:anatomy & histology* / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D015588:Observer Variation; D010369:Pectoralis Muscles / Q000098:blood supply*