Background: The internal mammary artery perforator (IMAP) flap can be used to reconstruct small to medium sized defects in the neck or chest. The main advantage of the flap is its minimal donor site morbidity and superior aesthetic outcomes. However, if a larger flap is harvested, breast deformity may develop. In an attempt to resolve this problem, we modified the usual elliptical design of the IMAP flap in a V-Y manner.

Methods: Bilateral IMAP based V-Y advancement flaps were used to reconstruct an unstable wound in the lower sternal area in a male patient. After wide excision of the scar, an IMAP based flap is drawn triangularly and transversely on each side of the wound. The flaps were based on two intercostal perforators of the internal mammary vessels in the fourth and sixth intercostal spaces and measured 12 × 14 cm, respectively. The perforators of the internal mammary vessels were identified in the parasternal area and then the flaps were raised to the level of the pectoralis major fascia from lateral to medial. When the flaps were elevated, one perforator of the intercostal vessels in the sixth intercostal space was identified and preserved in each flap to enhance flap vascularity. The raised flaps were then advanced to the recipient site and the flap donor and recipient sites were closed primarily in a V-Y manner.  

Results: Postoperative course was uneventful, and the flaps survived completely. Long-term follow-up showed good flap durability and elasticity.

Conclusions: The IMAP based V-Y advancement flap provides a convenient and reliable alternative for the reconstruction of soft tissue defects in the sternal region, particularly the lower sternal area.