“Opened Book Technique for Accessing the Internal Mammary Vessels for Microanastomosis

Abstract

The internal mammary (IM) vessels have been shown to be an excellent option for use as recipient vessels in microsurgical free tissue transfer. The authors preferentially use the IM vessels for all free flap breast reconstructions unless the IM perforators are suitable. Accessing the IM vessels in the past has involved the removal of an entire rib cartilage. Removal of an entire rib cartilage may be associated with increased postoperative pain, and a visible depression in the upper chest. In order to avoid these problems, they developed a method of accessing the IM vessels within the rib interspace, which does not require the removal of rib cartilage, is relatively bloodless, very reproducible, and can be performed under loupe magnification during the harvest of the free flap. The details of this procedure, which the authors call the “opened book” technique, were described in this report.