title: Internal mammary perforators as recipient vessels for deep inferior epigastric perforator and muscle-sparing free transverse rectus abdominis musculocutaneous flap breast reconstruction in an Asian population.
abstract: BACKGROUND
  The use of internal mammary perforators (IMPs) as recipient vessels in autologous free flap breast reconstruction has many additional benefits compared with the internal mammary or thoracodorsal vessels. Our goals were to analyze the characteristics of these vessels and to evaluate the reliability of using them in an Asian population.
  
  
  METHODS
  Thirty-five consecutive patients were prospectively studied between November 2000 and December 2010. Twelve patients underwent muscle-sparing-2 transverse rectus abdominis musculocutaneous flap, and 23 had deep inferior epigastric perforator flap reconstructions.
  
  
  RESULTS
  Internal mammary perforator vessels were used in 29 patients (83%). Most (75%) of the vessels were located in the subcutaneous plane, and 85% were in the second and third intercostal spaces. There were significantly more usable IMP vessels in the immediate than in the delayed reconstructions (P = 0.049). All the flaps in the study were successful despite 1 requiring emergency re-exploration because of venous congestion.
  
  
  CONCLUSIONS
  Most of the IMP vessels are small; however, they are still reliable and safe for use as recipient vessels in selected Asian patients. Most are located in the subcutaneous plane, which further facilitates dissection and also reduces recipient-site morbidity.
authors.affiliation: From the Reconstructive Sciences Department, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
authors.forename: Ahmad Sukari
authors.initials: AS
authors.lastname: Halim
authors.forename: Akmal Azim
authors.initials: AA
authors.lastname: Alwi
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D044466:Asian People; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery*; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008408:Mastectomy; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation; D061525:Perforator Flap / Q000098:blood supply / Q000637:transplantation; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D013524:Surgical Flaps / Q000098:blood supply* / Q000637:transplantation; D014182:Transplantation, Autologous; D014463:Ultrasonography