The IMAP flap for pharygoesophageal reconstruction following stricture release

Small-medium pharyngo-oesophageal or peri-tracheostoma defects represent a difficult reconstructive problem. Previous solutions included locoregional options such as the deltopectoral flap, or microvascular free tissue transfer. The authors present a novel application of the internal mammary artery perforator (IMAP) flap for reconstructing such defects. The IMAP flap may be mapped using pre-operative Doppler or CTA, and is raised on a single perforator. The relatively quick and simple flap raise provides robust fasciocutaneous tissue, may be tunneled subcutaneously to reach the neck and yields an inconspicuous donor site. The authors provide several cases demonstrating applications of the IMAP flap for reconstructing small-medium sized defects following release of annular pharyngoesophageal stricture, and studies documenting post-operative swallow. Overall, the pedicled IMAP fasciocutaneous flap is a useful technique to provide excellent composite tissue to reconstruct defects resulting from release of annular pharyngeal strictures. It is technically simple, and yields an inconspicuous anterior chest donor site.