Safe and Time-Saving Method for Pharyngeal Reconstruction Using an Internal Mammary Artery Perforator Flap

Head and neck squamous cell carcinoma often requires total laryngectomy (TL), creating complex defects, especially in irradiated patients. The internal mammary artery perforator (IMAP) flap is a promising reconstructive option, offering reliable vascularization with minimal donor site morbidity. However, postoperative characteristics such as retention/survival and complications in irradiated patients have not been fully addressed. A retrospective analysis was conducted on seven patients undergoing IMAP flap reconstruction after TL for advanced laryngeal carcinoma. All had prior radiotherapy. The procedures were designed using the Doppler ultrasound technique, and the second intercostal space IMAP was used in most patients, except for one. Flap elevation surgical time, defect coverage, complications, and hospital stay were evaluated. Our patients were 79 ± 4.3 years old. The average surgical time for flap elevation was 61 ± 5.34 minutes. The pharynx defect size was 4.57 ± 0.53 cm ² , achieving full coverage in all cases. The mean hospital length of stay was 4.0 ± 1.52 days. One patient developed a postoperative hematoma; no flap necrosis or fistulas occurred after 3 months of follow-up. The flap survival rate was 100%. In this work, our IMAP flap design could be considered thin and elongated; however, due to the constant blood flow of the IMAP, we observed reliable results, and no partial or total necrosis was reported. Thus, the IMAP flap is a safe and effective alternative for laryngeal defect reconstruction in irradiated patients, proving excellent viability, favorable aesthetics, reduced morbidity, and minimal complications.