Cutaneous vascular anatomy of pectoral skin flaps

The need for nondelayed skin flaps from the chest for postoperative reconstruction and repair has increased considerably since the advent of combined irradiation and surgical therapy for treatment of cancer of the head and neck. Survival of these pedicled flaps is of paramount concern to the surgeon, as flap necrosis can be catastrophic for the patient. Many parameters have been evaluated to predict flap viability, but recent studies strongly suggest that the arterial blood supply of the pedicle is the most important factor in the success of immediate transposition. A study was performed in 19 cadavers to delineate the cutaneous vascular anatomy of the chest in order to determine precisely where the perforating vessels of the thorax and shoulders supply the pedicle region of medially-based and laterally-based pectoral flaps. On the basis of this study, modification of the design of these flaps is recommended.