Useful Flaps for Plastic Surgeons to Know | Journal CME Article-Journal CME Article: Useful Flaps for Plastic Surgeons to Know (Video 2)

Video Transcription

The IMAP is a very versatile flap. It can be used to close defects in the anterior chest and the neck. It can also be used as a free flap.  This is a patient with a basal cell carcinoma at the root of the neck. You can see the size of the excision fairly extensive.  And this is going to be reconstructed with an IMAP flap. Here we see the IMAP flap with two perforators, two internal memory perforators.  And a clamp has been placed on the distal flap to ascertain that the proximal flap is going to be sufficient to vascularize the flap.  And you can do this either with clinical judgment or you can use endosining green to make sure that your flap is perfusing.  We have divided the more distal flap and ascertained that the flap can perfuse on the single perforator. And then this is rotated into the defect.  And it's a good idea to rotate it both clockwise and anticlockwise and listen with the Doppler to make sure that the signal is strong.  Sometimes flaps have a preference as to whether they're rotated clockwise or anticlockwise.

Video Summary

The IMAP flap is highly versatile for reconstructing defects in the anterior chest and neck and can be used as a free flap. In this case, it addresses a basal cell carcinoma at the neck's root, where significant excision is required. The IMAP flap is prepared using two internal mammary perforators to ensure adequate vascularization. The procedure involves testing perfusion with either clinical judgment or endosining green. After confirming that the flap can sustain itself on a single perforator, it is rotated into the defect, with checks using a Doppler to ensure optimal blood flow, considering directional preferences.

Keywords

IMAP flap

reconstruction

basal cell carcinoma

vascularization

Doppler