Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: the role of the internal mammary perforators.
BACKGROUND
Although the internal mammary (IM) vessels are our first choice as recipient vessels for free flap breast reconstruction, attempts to reduce surgical morbidity led us to adopt an algorithm when choosing recipient vessels.


METHODS
The IM vessels give direct perforators to the breast. They can be found either superficial or deep to the pectoralis major muscle. If they are of a reasonable calibre they can be considered as recipient vessels. When the perforators are not suitable, the IM vessels are used for the microanastomosis. This protocol was adopted for our patients between June 1999 and December 2002.


RESULTS
Breast reconstruction with free flaps was performed on 298 patients with perforator flaps. IM and thoracodorsal (TD) vessels are used in 88% and 3% of cases, respectively. IM perforators were successfully used in 30 cases (9%). The IM perforators used were located at the level of the second and third intercostal space in nine (30%) and 21 (70%) cases, respectively. The average diameters of those perforators were 1 mm (0.5-1.3 mm) for the artery and 1.7 mm (1-3 mm) for the vein.


CONCLUSIONS
The IM perforators can be used as recipient vessels for free flaps. This spares the IM vessels for eventual cardiac bypass surgery, avoiding recipient site morbidity and decreasing the postoperative discomfort.
Hamdi
Moustapha
M
Department of Plastic Surgery, Gent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
Blondeel
Phillip
P
Van Landuyt
Koenraad
K
Monstrey
Stan
S
D000465:Algorithms; D000714:Anastomosis, Surgical / Q000379:methods; D002102:Cadaver; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome