Deltopectoral Skin Flap As A Free Skin Flap Using The Internal Mammary Vessels, Revisited: Further Refinement in Flap Design, Fabrication, and Clinical Usage



Deltopectoral Skin Flap As A Free Skin Flap Using The Internal Mammary Vessels, Revisited: Further Refinement in Flap Design, Fabrication, and Clinical Usage


K. SASAKI

M. NOZAKI

T. HONDA

K. MORIOKA

Y. KIKUCHI

T. HUANG





The deltopectoral skin flap described by Bakamjian (1) in 1965 is an axial flap; therefore, it can be harvested as a free skin flap for distant transfer by means of a microsurgical technique (2, 3). This skin flap was useful for facial resurfacing because of excellent color and texture match. Shortness of the vascular pedicle and smallness of the vessel caliber, on the other hand, render flap revascularization technically difficult. The method is further plagued by problems attributable to bulkiness of the skin flap and morbidities associated with donor-site deformity. These problems have been ameliorated by extending the pedicle to the internal mammary vessel and defatting the flap.




ANATOMY

The lateral edge of the flap is bound by a line drawn 2 to 3 cm beyond the deltopectoral sulcus, alias Mohrenheim’s fossa. The boundary is especially important in individuals for whom a concomitant defatting/thinning of the skin flap is contemplated at the time of initial flap harvesting. The medial boundary of the flap is located usually at the sternal edge on the same side. The medial boundary of the flap can be expanded by 3 to 4 cm beyond the ipsilateral parasternal line, especially where a segment of the internal mammary vessel is included in fabricating a vascular pedicle.

Length and size of the vessel can vary depending on the location of the flap marked over the upper chest and the distance from the parasternal line. Diameter of the arterial pedicle can be increased from 0.9 to 2.9 mm by incorporating a segment of the internal mammary artery. Similarly, elongation of the vascular pedicle can be achieved by removing the skin and the soft tissues surrounding the vessels at the medial edge of the flap (Fig. 128.1).

Only gold members can continue reading. Log In or Register to continue

Jun 26, 2016 | Posted by in General Surgery | Comments Off on Deltopectoral Skin Flap As A Free Skin Flap Using The Internal Mammary Vessels, Revisited: Further Refinement in Flap Design, Fabrication, and Clinical Usage
Premium Wordpress Themes by UFO Themes