Internal mammary artery perforator (IMAP) flaps

Oncologic defects of the head and neck require a detailed understanding of regional anatomy to optimize and simplify reconstruction. While free tissue transfer has become the standard bearer for most soft tissue defects, local flaps still remain a high-quality, reliable option. The internal mammary vasculature provides predictable perforators to the chest wall skin that can be transposed to lower neck wounds. Paired arteries and veins perforate through the second and third rib interspaces to perfuse skin overlying the parasternal and infraclavicular areas. Donor site morbidity is minimal with primary closure performed in most occasions. This flap is ideal for smaller esophageal fistulae, paratracheal wounds, and neck incisional dehiscence.