title: Dual perforator propeller internal mammary artery perforator (IMAP) flap for soft-tissue defect of the contralateral clavicular area.
abstract: The internal mammary artery perforator (IMAP) flap represents the evolution from axially pedicled flaps (deltopectoral flap) to perforator flaps. Both flaps are typically used for neck and tracheostoma reconstruction in male patients. We present the case of a 68-year-old obese female patient with a right upper thoracic radionecrosis secondary to breast irradiation. Soft-tissue defect measured 12×18 cm. She also complained of left breast hypertrophy. Following radical debridement, a left IMAP flap extending from midline to the anterior axillary fold was raised, based on the second and fourth IMAP vessels. The flap was rotated 180° on its second and fourth perforators to cover the defect and the left breast was reshaped. The flap survived entirely and wound healing was uneventful. Ptosis and breast hypertrophy were corrected at the same time. The IMAP flap can be harvested all the way to the anterior axillary fold and used as a large propeller flap, which makes this flap suitable for contralateral thoracic reconstructions, even in female patients.
authors.affiliation: Department of Plastic Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
authors.forename: Eva Meia
authors.initials: EM
authors.lastname: Rüegg
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
authors.forename: Alexandre
authors.initials: A
authors.lastname: Marchac
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002968:Clavicle; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008323:Mammary Arteries / Q000601:surgery; D008408:Mastectomy / Q000379:methods; D009336:Necrosis / Q000473:pathology; D009767:Obesity, Morbid; D061525:Perforator Flap / Q000098:blood supply*; D011832:Radiation Injuries / Q000473:pathology*; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology