Anatomical study concerning the origin and course of the pectoral branch of the thoracoacromial trunk for the pectoralis major flap

The patterns of the feeding vessels to each muscle determine the extent of their safe transposition and the muscle's value as a pedicled flap in reconstructive surgery. This study aimed to demonstrate the point of origin and the intra- and submuscular course of the pectoral branch of the thoracoacromial trunk (TAT) for pectoralis major (PM) flap surgery. Seventy sides of the PM were dissected based on a clinical reference line that has been used for several decades. The branching point of the TAT from the axillary artery was located lateral to the midclavicular line on the right-sided specimens (100%) and medial to the midclavicular line on the left sides (86%). The branching patterns of the pectoral branch to the PM muscle from the TAT were classified into three types. In type I the pectoral branches originated directly from the TAT (55 cases, 78.6%). In type II (11 cases, 15.7%) and type III (4 cases, 5.7%) the pectoral branch divided from the medial and lateral pedicle of the TAT, respectively. The course of the pectoral branch from the TAT in the PM was categorized into three patterns according to the degree of proximity to the midclavicular line. In 49 cases (70%), the pectoral branch in the PM ran within 1 cm of the midclavicular line. The other cases ran 2 cm (20 cases, 29%) and 3 cm (1 case, 1%) from the midclavicular line, respectively. These results provide topographic data of the pectoral branch based on anatomical landmarks, and will be useful in surgical planning as well as the procedure for PM flap surgery.