title: Lymph fasciocutaneous lateral thoracic artery flap: anatomical study and clinical use.
abstract: BACKGROUND
  The lateral thoracic flap was first studied in the mid-1970s but its use has been limited because of pedicle anatomical variations. However, after the development of lymph node transfer surgery, the axilla/upper lateral thorax presented as a promising donor area. Through a detailed anatomical study, the lateral thoracic flap was evaluated regarding its vascularization and composition. Later, it was used for pedicle and free flap reconstructions.
  
  
  METHODS
  A total of 40 flaps were dissected in fresh cadavers and the characteristics of the lateral thoracic pedicle and its relationship to the upper lateral thoracic axillary lymph nodes (LTLN) were analyzed. We performed six pedicle flap reconstructions around the shoulder area and a free lymph node transfer for lower limb lymphedema.
  
  
  RESULTS
  In the cadaveric dissections, the lateral thoracic pedicle branched off the axillary vessels and was found to be a primary level I axillary lymph node irrigator before reaching the skin. The cutaneous portion of the artery was present in 87.5% of the dissections. Arterial caliber was an average of 1.3 and venous, 2.6 mm. Five to seven lymph nodes were isolated with each pedicle and a lymph fasciocutaneous flap could be designed. In seven clinical cases, all of the flaps survived. Functioning lymph nodes were visualized on lymphoscintigraphy after their transfer to the ankle. Donor area had an inconspicuous evolution.
  
  
  CONCLUSIONS
  Lateral thoracic flap is a feasible flap with low donor area morbidity in a concealed region that can be harvested with upper LTLN for transplantation.
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Guilherme Cardinali
authors.initials: GC
authors.lastname: Barreiro
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Rachel Rossine
authors.initials: RR
authors.lastname: Baptista
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Kiril Endo
authors.initials: KE
authors.lastname: Kasai
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Daniel Marchi
authors.initials: DM
authors.lastname: dos Anjos
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Fabio de Freitas
authors.initials: Fde F
authors.lastname: Busnardo
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Modolin
authors.affiliation: Division of Plastic Surgery, University of São Paulo, Medical School, São Paulo, SP, Brazil.
authors.forename: Marcus Castro
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000098:blood supply / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps / Q000098:blood supply*; D013895:Thoracic Arteries / Q000637:transplantation*; D055815:Young Adult