We used contralateral internal mammary artery perforator (IMAP) flaps for reconstruction of small-to-medium-sized chest wall defects. The IMAP flaps were used in two patients who had an unhealed, localized ulcer of the chest wall with exposure of ribs following radical mastectomy. After the lesion was widely excised, the flap, based on a perforator vessel in the second or third intercostal space of the contralateral chest wall, was elevated. The flap was rotated from 90 to 180 degrees along the vascular axis to the contralateral chest wall defect. The donor site was closed primarily. Both flaps showed stable postoperative blood circulation and survived completely. The chest wall defects were able to be covered with healthy, well-vascularized tissue on one perforator without deep infection. The IMAP flap is a reliable and less invasive option to be considered for medial, localized, chest wall reconstruction.
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