title: Internal Mammary Artery Perforator-Supercharged Prefabricated Cervicothoracic Flap for Face and Neck Reconstruction.
abstract: BACKGROUND
  Prefabricated flap is an important technique to reconstruct massive face and neck skin defects. But its vascularization remains unpredictable and often leads to abnormal blood supply of the harvested flap, even necrosis. Flap supercharging and turbo supercharging techniques are effectively used to improve flap blood supply. However, few studies have been reported on the application of these techniques in prefabricated induced expanded flaps.
  
  
  METHODS
  From March 2008 to September 2012, 13 patients who have face and neck soft tissue defects were treated with prefabricated cervicothoracic flap. To overcome insufficient blood supply, 5 of them received additional microvascular augmentation in which the second or third perforator of the internal mammary artery (IMAP) and its venae comitantes were anastomosed to facial or superficial temporal vessels, contrary to the remaining 8 patients. The following results were compared: flap viability, hospital stay, complications, frequency of dressing change, reoperation rate, and remaining scars.
  
  
  RESULTS
  No flap necrosis was observed in patients who received the supercharging procedure. By contrast, of the 8 patients who were not treated with supercharging technique, various degrees of flap necrosis occurred in 3 patients, 2 of whom received secondary operations. The frequency of dressing changes, the hospital stay, and hospital cost were reduced. Postoperative view showed better aesthetic restoration.
  
  
  CONCLUSIONS
  The IMAP-supercharged cervicothoracic flap technique offers a reliable method for massive face and neck reconstruction. We recommended that the IMAP should always be preserved in the flap as a saving option for potential flap congestion or arterial insufficiency.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou; and †Department of Plastic and Reconstructive Surgery, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors.forename: Guang-Shuai
authors.initials: GS
authors.lastname: Li
authors.forename: Tao
authors.initials: T
authors.lastname: Zan
authors.forename: Qing-Feng
authors.initials: QF
authors.lastname: Li
authors.forename: Haizhou
authors.initials: H
authors.lastname: Li
authors.forename: Ming-Min
authors.initials: MM
authors.lastname: Dong
authors.forename: Lin-Bo
authors.initials: LB
authors.lastname: Liu
authors.forename: Bin
authors.initials: B
authors.lastname: Gu
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.forename: Shuang
authors.initials: S
authors.lastname: Ding
authors.forename: Yan
authors.initials: Y
authors.lastname: Zheng
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.forename: Yun
authors.initials: Y
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D009333:Neck / Q000601:surgery*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult