title: The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.
abstract: Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications.
authors: *American University of Beirut Medical Center, Beirut, Lebanon †The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Amir
authors: A
authors: Ibrahim
authors: Bishara
authors: B
authors: Atiyeh
authors: Reem
authors: R
authors: Karami
authors: David M
authors: DM
authors: Adelman
authors: Nazareth J
authors: NJ
authors: Papazian
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D007825:Laryngectomy; D008323:Mammary Arteries / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D061525:Perforator Flap / Q000098:blood supply* / Q000601:surgery*; D056144:Pyriform Sinus / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply* / Q000601:surgery*; D014062:Tongue Neoplasms / Q000601:surgery*