Internal mammary artery

flap
Supply
Supply
Landmark
• The lateral edge of the sternum (Fig. 35.1)
marks the medial aspect of the flap, the
clavicle marks the superior aspect of the
flap, the lower aspect of the 4th rib
denotes the inferior aspect of the flap,
and the lateral aspect of the flap, without
a delay procedure, is 3–4 cm lateral and
parallel to the deltopectoral groove.
• The superior and inferior limits of the flap
may be adjusted based on the perforator
chosen.
• The flap can be centered over one
perforator, preferably the largest (the
second or third perforator).
INTERNAL MAMMARY ARTERY
PERFORATOR FLAP
• This flap may be based on any of the upper four internal mammary perforators.
• The skin incisions are made in traditional DP flap fashion.
• A supra- or subfascial dissection is then performed until the perforator is
visualized.
• Then dissected through the intercostal musculature.
• Costal cartilage can then be removed on either side, which allows access to the
distal internal mammary vessels.
• Vessel are located just underneath the perichondrium of the rib. These vessels
can then be safely ligated and divided, which then maximizes the arc of rotation
for the pedicled flap