Distribution of internal thoracic artery perforators: A clincal anatomy study

Abstract

There are various modifications of the transverse rectus abdominis musculocutaneous flap and deep inferior epigastric perforator flap to reduce the morbidity of the donor site or to augment the vascularity of the flap. For microanastomosis of multiple pedicles, multiple recipient vessels or an intervening vein graft should be provided. In addition, alternative perforator-based flaps used in breast reconstruction have small caliber pedicles. Therefore, small recipient vessels such as internal thoracic artery perforators are more suitable for appropriate microanastomosis. Therefore, it is important to acquaint the distribution and anatomical characteristics of internal thoracic artery perforators. We researched the perforators running in the intercostal spaces under the pectoralis major muscle to provide an overview of the anatomical distribution and characteristics of the perforators in patients who underwent immediate subpectoral implant-based breast reconstructions. In our study, the major perforators (diameter > 1.5 mm) were easily found 2-7 cm medially between the third and fourth intercostal space and were sparse in the lateral area from the midline of the breast (usually 8-9 cm lateral to the midsternal line) and above the third rib. In each side of the breast, the average number of perforators greater than 1.5 mm was 1.6, and the average number of perforators between 1 mm and 1.5 mm in diameter was 3.2.Our results provide information about perforators in the anterior chest wall related to the breast area. Clin. Anat. 32:471-475, 2019.

Reconstruction of the thoracic radiation-induced ulcer with the pedicled internal mammary artery fasciocutaneous flap: Review of the literature and a case report

“…Accompanying each artery are two venous commitans. 12 , 13 Based on a single or double perforator of the internal mammary artery, the IMAP flap uses the same type of vascular supply as the deltopectoral flap. It offers an excellent option for local tissue with matching skin texture and colour for head and neck reconstruction.…”

“…Chest-wall RIU in women with large ptotic contralateral breast can be good candidates for this technique. 12 , 13 In this paper, we present the use of an IMAP flap to treat a recurrent chest-wall RIU in a patient with a history of failure of latissimus dorsi flap and lateral intercostal perforator flap.…”

Repair of Breast Defect by Transfer of a Contralateral Internal Mammary Artery Perforator Flap

“…The internal mammary artery emanates anterior intercostal branches and perforators in the first to sixth intercostal spaces, and the main perforators (with a diameter greater than 1.5 mm) are easily found 2–7 cm from the medial side in the third and fourth intercostal spaces. 4 The internal mammary artery perforators and the lateral thoracic artery perforators anastomose with each other in the breast parenchyma and behind the nipple–areola complex, forming an arterial network. Some scholars have reported that immediate or delayed breast reconstruction can be performed by using the contralateral internal mammary artery perforator flap to repair wound defects after mastectomy.…”