Deltopectoral skin flap as a free skin flap revisited: Further refinement in flap design, fabrication, and clinical usage

The deltopectoral skin flap is an axial flap; therefore, it can be fashione d as a free skin flap. Although color and texture of the skirt are well sui ted for. facial resurfacing, the structural features of inconsistent thickn ess of the skin, a short vascular pedicle, a minute caliber of the nutrient vessel, and donor site morbidity often preclude the use of this flap for t his purpose. Tile deltopectoral skin nap fabricated as a free skirt flap tr ansfer ted by means of a microsurgical technique was used ill 27 patients b etween 1985 and 1998 at our hospital. The anterior perforating branches of the internal mammary vessels were the primary nutrient vessels of the nap i n seven instances. The external caliber of this artery varied between 0.6 m m and 1.2 mm, with an average size of 0.9 mm. The size of the accompanying vein varied between 1.5 mm and 3.2 nlm, with an ave rage of 2.3 rn m. Coapt ation of first vessels wi th those in the recipient site was technically di fficult. Thrombosis occurred at the anastomotic site in three patients, req uiring reoperation. Two flaps were sated. The flap failure was drastically reduced in the remaining 20 patients by including a segment of the internal mammary vessel M hen Fabricating the vascular pedicle. The size of the int ernal mammary arterial segment averaged 2.1 mm. and the average size oi the accompanying vein was 2.9 mm. The problem of a bulky flap was managed bp s urgical defatting/ thinning of the flap at the time of flap fabrication and transfer. A V-to-Y skin nap advancement technique of wound closure was use d in eight individuals. The flap donor-site morbidities were minimized with this method of wound closure.