The Internal Mammary Artery Perforator Flap: An Anatomical Study and a Case Report

The anatomic basis for the internal artery mammary perforator (IMAP) flap is described in this cadaveric study, together with a clinical case report. The IMAP flap is based on a single or double perforator of the internal mammary artery that is included in the pedicle for added length. It provides a very useful source of local tissue with skin of good texture and color for head and neck reconstruction and, being muscle free, is thin. With preservation of the anterior cutaneous branch of the intercostal nerve, the flap has the potential to be sensate. A large area can be covered, particularly if bilateral flaps are raised. The donor site can be closed directly. In selected patients, it offers an excellent option for use in head and neck reconstruction and should be considered as an alternative to the deltopectoral and pectoralis major flaps.

[1]  R. Ogawa,et al.  Bipedicled free super-thin flap harvesting from the anterior chest. , 2004, Plastic and reconstructive surgery.

[2]  D. Pennington,et al.  The microvascular augmented subdermal vascular network (ma-SVN) flap: its variations and recent development in using intercostal perforators. , 2002, British journal of plastic surgery.

[3]  L. Luria.  Medicare reform house floor speech by Congressman Dr. Gregory Ganske, June 6, 2001. , 2002, Plastic and reconstructive surgery.

[4]  G. Maillard.  Breast reconstruction with the internal mammary artery pedicled fasciocutaneous island flap: description of a new flap. , 2002, Plastic and reconstructive surgery.

[5]  A. B. Karabulut,et al.  INTERNAL MAMMARY ARTERY PEDICLED ISLAND FLAP FOR THE TREATMENT OF CHEST WALL RADIONECROSIS , 2001, Plastic and reconstructive surgery.

[6]  K. Sasaki,et al.  Deltopectoral Skin Flap as a Free Skin Flap Revisited: Further Refinement in Flap Design, Fabrication, and Clinical Usage , 2001, Plastic and reconstructive surgery.

[7]  H. Aydın,et al.  Breast Reconstruction with the Internal Mammary Artery Pedicled Fasciocutaneous Island Flap: Description of a New Flap , 2000, Plastic and reconstructive surgery.

[8]  E. Silberstein,et al.  Chicken bones: an unusual foreign body. , 1999, Plastic and reconstructive surgery.

[9]  A. Schwabegger,et al.  Internal mammary artery and vein. , 1997, Plastic and reconstructive surgery.

[10]  Lu-Jean Feng,et al.  Recipient Vessels in Free‐Flap Breast Reconstruction: A Study of the Internal Mammary and Thoracodorsal Vessels , 1997, Plastic and reconstructive surgery.

[11]  R. Allen,et al.  The Internal Mammary Artery and Vein as a Recipient Site for Free‐Flap Breast Reconstruction: A Report of 110 Consecutive Cases , 1996, Plastic and reconstructive surgery.

[12]  A. Schwabegger,et al.  Internal mammary vessels: anatomical and clinical considerations. , 1995, British journal of plastic surgery.

[13]  A. Schwabegger,et al.  Internal mammary vessels: a reliable recipient system for free flaps in breast reconstruction. , 1995, British journal of plastic surgery.

[14]  L. Valdatta,et al.  Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction. , 1995, British journal of plastic surgery.

[15]  L. Brander.  The Arterial Anatomy of Skin Flaps , 1989 .

[16]  G. I. Taylor,et al.  The vascular territories (angiosomes) of the body: experimental study and clinical applications. , 1987, British journal of plastic surgery.

[17]  J. Palmer,et al.  The vascular territories of the anterior chest wall. , 1986, British journal of plastic surgery.

[18]  Y. Miyamoto,et al.  One-stage ante-thoracic reconstruction of the thoracic oesophagus using myocutaneous flaps. , 1984, British journal of plastic surgery.

[19]  D. Liu,et al.  Thermal Orbital Injuries from Disposable Cauteries , 1984, Plastic and reconstructive surgery.

[20]  G. I. Taylor,et al.  The vascular territory of the acromiothoracic axis. , 1984, British journal of plastic surgery.

[21]  G. I. Taylor,et al.  The Vascular Territories of the Superior Epigastric and the Deep Inferior Epigastric Systems , 1984, Plastic and reconstructive surgery.

[22]  Y. Maruyama,et al.  The definition of vascular skin territories with prostaglandin E1--the anterior chest, abdomen and thigh-inguinal region. , 1981, British journal of plastic surgery.

[23]  C. Krag,et al.  The Deltopectoral Flap , 1980 .

[24]  R. Hamaker.  Four chest flaps. , 1978, Archives of otolaryngology.

[25]  R. Hamaker,et al.  Bilobed chest flap. , 1977, Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology.

[26]  T. Gibson,et al.  The mammary artery pectoral flaps of Jacques Joseph. , 1976, British journal of plastic surgery.

[27]  R. Daniel,et al.  THE ANATOMY OF SEVERAL FREE FLAP DONOR SITES , 1975, Plastic and reconstructive surgery.

[28]  D. M. Cunningham,et al.  The deltopectoral flap: an anatomical and hemodynamic approach. , 1975, Plastic and reconstructive surgery.

[29]  K. Harii,et al.  Free deltopectoral skin flaps. , 1974, British journal of plastic surgery.

[30]  I. McGregor,et al.  Axial and random pattern flaps. , 1973, British journal of plastic surgery.

[31]  P. Tessier.  TOTAL OSTEOTOMY OF THE MIDDLE THIRD OF THE FACE FOR FACIOSTENOSIS OR FOR SEQUELAE OF LE FORT III FRACTURES , 1971, Plastic and reconstructive surgery.

[32]  J. Conley.  One-stage reconstruction of pharynx and cervical esophagus with chest flap. , 1969, Bulletin of the New York Academy of Medicine.

[33]  V. Bakamjian.  A TWO-STAGE METHOD FOR PHARYNGOESOPHAGEAL RECONSTRUCTION WITH A PRIMARY PECTORAL SKIN FLAP. , 1965 .

[34]  J. Conley.  XCVII The Use of Regional Flaps in Head and Neck Surgery , 1960 .

[35]  J. Conley.  The use of regional flaps in head and neck surgery. , 1960, Transactions of the ... annual meeting of the American Laryngological Association. American Laryngological Association. Annual Meeting.

[36]  J. Joseph.  Nasenplastik und sonstige Gesichtsplastik : nebst einem Anhang über Mammaplastik und einige weitere Operationen aus dem Gebiete der äusseren Körperplastik : ein Atlas und Lehrbuch , 1931 .