Three-Dimensional Analysis of the Internal Mammary Artery Perforator Flap

Abstract

The internal mammary artery perforator flap is a versatile flap used for reconstruction of the head and neck. Using dissection, angiograms, and three-dimensional reconstruction, the authors describe the vascular anatomy of the internal mammary perforator arteries, including their course, diameter, location of perforation, and relationship to other tissues (e.g., bone, muscle, and skin). Fourteen fresh cadavers were injected with either latex or a lead oxide/gelatin mixture and dissected to show the anatomy of the internal mammary artery perforators. Plain film and computed tomographic angiograms were obtained and analyzed on the lead oxide-injected cadavers. The computed tomographic angiography Digital Imaging and Communications in Medicine images were imported into Materialise's Interactive Medical Imaging Control System software to produce three-dimensional reconstructions of the internal mammary artery perforator anatomy. The second internal mammary artery perforator was the dominant perforator in 10 of the 14 cadavers. The mean emerging diameter of the dominant second perforator was 1.0±0.4 mm, with a mean superficial length of 51.8±16.1 mm on the latex-injected and lead oxide-injected cadaver angiograms. The mean distance from the sternal margin to the point of emergence from the internal mammary artery was 7±1.4 mm. The three-dimensional reconstructions demonstrated anastomoses between the dominant perforator and the lateral thoracic artery. The vascular anatomy of the internal mammary artery perforators was documented using cadaveric dissections, angiograms, and computed tomographic angiograms analyzed with Materialise's Interactive Medical Imaging Control System. The diameter, point of perforation, course, and relationship to surrounding anatomical structures has been shown using a vascular injection technique and three-dimensional reconstructions.