Surgical and Radiologic Anatomy

, Volume 40, Issue 8, pp 911–916 | Cite as

Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study

  • François Morel
  • Frédéric Crampon
  • Jérôme Adnot
  • Pierre-Yves Litzler
  • Fabrice Duparc
  • Olivier TrostEmail author
Original Article



Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions.


We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured.


In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm.


Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.


Anatomy Biometry Internal thoracic artery Internal thoracic vein Microsurgery. 



The authors are grateful to Richard Medeiros, Medical Editor, for his expert editing of the manuscript. Thank you to Mr. Bruno Belloncle of the Laboratory of Anatomy for his appreciated technical help and logistic support.

Author contributions

Protocol/project development: FM, P-YL, FD, OT. Data collection or management: FM, FD. Data analysis: FM. Manuscript writing/editing: FM, FC, JA, P-YL, FD, OT.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest related to this study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • François Morel
    • 1
  • Frédéric Crampon
    • 2
  • Jérôme Adnot
    • 1
  • Pierre-Yves Litzler
    • 3
    • 4
  • Fabrice Duparc
    • 2
  • Olivier Trost
    • 1
    • 2
    • 5
    Email author
  1. 1.Department of Oral and Maxillofacial SurgeryRouen University HospitalRouenFrance
  2. 2.Laboratory of AnatomyRouen Faculty of MedicineRouenFrance
  3. 3.Department of Thoracic and Cardiovascular SurgeryRouen University HospitalRouenFrance
  4. 4.French National Institute for Health (INSERM), U-1096RouenFrance
  5. 5.French National Institute for Health (INSERM), LIMICS UMR-1142RouenFrance

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