Department of Plastic Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
J Plast Reconstr Aesthet Surg. 2012 Oct;65(10):1414-7. doi: 10.1016/j.bjps.2012.03.009. Epub 2012 Apr 13.
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.
内乳动脉穿支（IMAP）皮瓣代表了从轴形蒂皮瓣（胸大肌皮瓣）向穿支皮瓣的演变。这两种皮瓣通常用于男性患者的颈部和气管造口重建。我们报告了一例 68 岁肥胖女性患者，因乳房照射继发右上胸放射性坏死。软组织缺损大小为 12×18cm。她还抱怨左乳房肥大。在彻底清创后，基于第二和第四 IMAP 血管，从中线向腋前皱襞提起了一个左侧 IMAP 皮瓣。皮瓣通过第二和第四穿支旋转 180°以覆盖缺损并重塑左侧乳房。皮瓣完全存活，伤口愈合顺利。同时纠正了下垂和乳房肥大。IMAP 皮瓣可以一直延伸到腋前皱襞，并用作大型螺旋桨皮瓣，这使得该皮瓣适用于对侧胸部重建，甚至适用于女性患者。
