Discussion of: The anatomic basis of the internal mammary artery perforator flap: a cadaver study.

摘要

The authors are to be complemented on completing a much more thorough anatomic assessment of the IAAAP territories than we did in our publication. This study gives us new and important information on the potential territories supplied by these perforators as well as suggestions on how flaps might be designed based on these vessels. Further dissection to mobilize the underlying internal mammary artery greatly increases the arc of rotation of these flaps. The further dissection required to achieve this involves resection of one or more costal cartilages using techniques exactly similar to what we use to access the internal mammary vessels when doing a microvascular breast reconstruction. This manoeuver allows for rotation of these flaps up into the neck with minimal tension. The flap can also be mobilized distally in order to reach the upper abdomen. This increases the versatility of the flap. From my perspective, the greatest benefit of this flap is that it allows for mobilization of chest skin without muscle harvest while, in most cases, allowing for direct closure of the donor defect. The authors are again to be congratulated on expanding our knowledge of the vascular anatomy of this very useful flap.