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 fashioned as a free skin flap. Although color and texture of the skirt are well suited for facial resurfacing, the structural features of inconsistent thickness 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 this purpose. The deltopectoral skin nap fabricated as a free skirt flap transfer ted by means of a microsurgical technique was used in 27 patients between 1985 and 1998 at our hospital. The anterior perforating branches of the internal mammary vessels were the primary nutrient vessels of the nap in seven instances. The external caliber of this artery varied between 0.6 mm 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 average of 2.3 rn m. Coaptation of first vessels with those in the recipient site was technically difficult. Thrombosis occurred at the anastomotic site in three patients, requiring 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 internal mammary arterial segment averaged 2.1 mm, and the average size of the accompanying vein was 2.9 mm. The problem of a bulky flap was managed bp surgical 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 used in eight individuals. The flap donor-site morbidities were minimized with this method of wound closure.