Dağhan Dağdelen, Görkem Kazaz, Yunus Emre Ede
Turkish Journal of Plastic Surgery - 2025;33(4):191-194
Case Report introduction The deltopectoral flap (DPF)[1] gained popularity in head and neck surgery in the late 1960s. Over time, it was largely replaced by the pectoralis major myocutaneous flap (PMMC). Currently, the DPF has a limited role as a backup option in head and neck surgery, where free flap reconstruction is frequently employed. The DPF, unlike the PMMC, lacks muscle bulk, making it thinner and relatively easier to shape. Furthermore, partial flap loss is a frequent complication in the distal portion of the flap. Modifications such as a wider flap base have been proposed to prevent this issue.[2] However, these modifications often necessitate skin grafting at the donor site and can lead to contour deformities in the anterior chest wall. The internal mammary artery perforator (IMAP) flap can be considered a refined version of the DPF. Compared to the DPF, it offers superior esthetic outcomes and minimal donor site morbidity. Its use is well-documented in the literature, particularly for upper neck defect reconstruction.[3] The flap is nourished by parasternally located perforators of the IMA. While cadaveric studies have demonstrated that a single dominant perforator can supply the entire hemithorax,[4] the size of fasciocutaneous flaps harvested in clinical practice remains limited. In this case, we used a bilobed IMA perforator flap to reconstruct a skin defect of the manubrial region following a skin cancer excision. To the best of our knowledge, this is the largest reported flap perfused by a single perforator. By presenting this successful reconstruction, we aim to demonstrate the feasibility and safety of using larger IMAP flaps in reconstructive surgery. case report A 79-year-old male patient presented with a mass at the upper border of the incision scar from a bypass surgery [Figure 1a]. An incisional biopsy confirmed squamous cell carcinoma. There was no clinical sign of metastasis at the axillary regions bilaterally, and the metastasis work-up, including computed tomography and positron emission tomography scans deemed negative. The patient's medical history included atrial fibrillation, third-degree atrioventricular block, chronic renal failure, coronary artery bypass graft surgery
