Reconstruction of the anterior chest wall using the internal mammary artery perforator flap (IMAP): About a series of 23 cases

Abstract

Background: The advent of propeller flaps has permitted new and less invasive coverage solutions for thoracic defects compared to conventional flaps. Through a retrospective analysis of our cases, we would like to show the advantages of the internal mammary artery perforator (IMAP) flap for anterior chest wall reconstruction.Methods: We included patients who underwent anterior chest wall reconstruction with an IMAP propeller flap in the Toulouse University Hospital's plastic surgery department from January 2019 to December 2022. The data were collected on patient data, skin defects, and flap characteristics.Result: 23 IMAP flaps were realized to cover locoregional defects. The skin paddle size of the IMAP flap averaged 15.6 cm long (12-20) x 6.7 cm wide (4-10). The average arc of rotation of the flap was 113.5° (range 70-140). In 3 cases, the IMAP flap was performed with a Superior Epigastric Artery Perforator Flap (SEAP). In 3 cases out of 23, the flap partially necrotized, requiring surgical revision. In 1 case, the flap was fully necrotized and had to be removed.Discussion and conclusion: Our series of 23 IMAP flaps on thoracic reconstruction is one of the largest published to date. Our series shows that the IMAP flap offers a simple and reliable solution with minor donor site morbidity for reconstructing small to medium-sized defects in the medial and paramedian regions of the chest wall.