부산대학교 도서관

Understanding the vascular anatomy of an individual perforator relative to its vascular territory is essential to optimal flap design. Being the definition of the distal vascular territory one of the limitations of local perforator flaps, there are often problems with venous drainage and distal necrosis. With the classic design of perforator flap of the internal mammary artery (IMAP) based deltopectoral flap, these problems were common at certain lengths. With a better definition of axiality and a redesign we can diminish it. The study’s aim was to investigate the axiality of this perforator in the thorax to optimize IMAP flap design. The course of the internal mammary perforator in a prospective, single-blind, cohort study in 140 consecutive patients undergoing multidetector-row computed tomographic (MDTC) angiography for follow-up in various pathologies was carried out. Patients who had had chest surgery were excluded. All of the angiographic studies were performed in the same center and the assessment was done in collaboration with the same radiologist. The anatomical course of the dominant internal mammary perforator was mapped and measured on both sides of the chest in relation to anatomical references such as the nipple-areola complex. 16 anatomical specimens, 32 internal mammary perforators, 10 fresh cadavers and 6 in a Cambdrige solution were dissected. Caliber, length and course measurements in relation to the nipple-areola complex were performed. MDCT revealed the course of the dominant perforator in all cases. The largest diameter was located in the second intercostal space in 58% of the cases. The perforating vessel axiality ran towards the nipple-areola complex in 64% of the patients. Likewise, the path of the piercing toward the nipple-areola complex has been observed in anatomical dissections. Clinical IMAP flap applications in head and neck reconstruction, its main indication, were discussed. Also the chest defects’ reconstruction, contrasting the previous design, and the proposed new IMAP flap design, and new indications such as breast’s reconstruction were discussed. The dominant axiality pattern of the dominant internal mammary perforator vessels in the IMAP flap was determined. With the new design for this flap, a decrease in the distal vascular problems rate was even observed in big flaps.