title: A novel salvage approach for pedicle axial flap--free-ization of pedicle internal mammary artery perforator flap.
abstract: A pedicle flap with distal segment compromise is classically managed by allowing tissue demarcation, debridement of non-viable tissue, and local tissue manipulation to achieve wound closure. When aggressive debridement leaves insufficient tissue for defect coverage, the original flap is often discarded. We present a case of distal necrosis of a pedicle internal mammary artery perforator flap for cheek reconstruction. The flap, which was rendered too small after debridement for defect coverage in its pedicle form, was converted to a free flap. The technical details of such conversion and potential feasibility of applying this conversion to other compromised pedicle flaps are discussed. We hypothesized that the principle of "free-ization" can be applied effectively for salvage of other failing pedicle flaps with axial blood supply.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, IA, USA.
authors.forename: Wei-Fan
authors.initials: WF
authors.lastname: Chen
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017211:Treatment Failure