IMAP Flap—A New Option for Head and Neck Reconstruction

This paper presented the authors' experience with the internal mammary artery perforator (IMAP) flap. It has evolved as a progression from the deltopectoral flap and other similar flaps previously described. It is based on the perforators of the internal mammary artery and combines our current understanding of cutaneous arterial anatomy and physiology with the classic deltopectoral flap. Careful dissection of the perforator and mobilization of the internal mammary vessels by costal cartilage resection allow rotation of the flap to cover defects in the neck and clavicular area.

Dissection and perfusion studies were performed in 5 fresh cadavers to detail the anatomy and to establish the safe limits of the IMAP flap. The dominant perforator is inconstant and varies from side to side and between patients. The area reliably perfused by any one perforator is large and extends from the clavicle to the xiphisternum, and the anterior axillary line to the mid-line. Greatest flap length can be obtained by orienting the flap obliquely across the chest.

Clinical cases were discussed individually. To date, these have included oblique flaps for neck resurfacing, and vertical flaps for pharyngeal reconstruction and parastomal repair.

The IMAP flap provides good quality local tissue which can be made sensate. It will safely reach to the jaw line and is suitable for a variety of reconstructive uses. In selected patients, it offers an excellent alternative to either the deltopectoral or pectoralis major flaps.