Deltopectoral island flap.

The medially based deltopectoral flap is a proven, reliable, and useful tool in the practice of head and neck and reconstructive surgery. Despite its versatility the flap has several limitations that restrict its use; these include a limited arc of rotation and significant risk of distal flap necrosis when increased length is incorporated from the deltoid region. By conversion of the conventional, parasternally based deltopectoral flap into an island flap supplied by one or two perforating branches of the internal mammary artery, its versatility can be markedly enhanced. This modification provides a free axis of rotation with virtually unrestricted spatial orientation and critical additional length. Furthermore, the island flap itself can be incorporated into the donor-site region, allowing primary closure of this defect. The dependability of this flap stems from the axial nature of the blood supply to the pectoral region. This factor, together with the free axis of rotation, affords the island flap its superiority over the standard deltopectoral flap. We have used this flap a total of 19 times (16 island and 3 free flaps) with notable clinical success and no observed failures. A description of technique and clinical applications will be discussed.