The vascular territories of the anterior chest wall.

A series of 31 fresh cadaver injection, dissection and radiographic studies were undertaken to define the vascular architecture of the anterior chest wall and to correlate the findings of previous writers in this area. The findings confirmed that the dominant supply to this region is from the internal thoracic artery which interconnects in all layers with the posterior intercostals, the lateral thoracic, the acromio-thoracic and the transverse cervical arteries. The dominant cutaneous perforators of these vessels are concentrated around the perimeter of the pectoralis major muscle, the costal margin and over the interdigitations of the serratus anterior muscle in the mid-axillary line. The clinical significance of these findings is discussed with particular reference to the design of various breast reduction procedures and the planning of flaps in this area. Of special note is the observation that the concentration of large perforators which exists along the inframammary crease arises from the anterior intercostal vessels in the fifth and sixth intercostal spaces.