Case 11 2026: Dual Internal Mammary Artery Perforator Propeller Flap for Anterior Chest Wall Reconstruction

Keywords: chest wall reconstruction, internal mammary artery, perforator flap, propeller flap, plastic surgery, squamous cell carcinoma, Mohs surgery Authors: Nelson Ramirez Lozano. Oncólogos de Occidente Manizales, Hospital de Santa Sofía Manizales, Colombia Alejandro Angelillis Osorio. Surgical Assistant, Oncologos de Occidente, Manizales, Colombia. Abstract Reconstruction of anterior chest wall defects following skin cancer resection represents a significant surgical challenge. We report a successful case utilizing a propeller flap based on two perforators of the internal mammary artery for reconstruction, achieving stable soft tissue coverage without generating additional donor-site deformity. Patient medical history A male patient in his sixth decade of life was referred with an anterior chest wall defect measuring approximately 8 × 12 cm in diameter, resulting from resection of a squamous cell carcinoma via Mohs micrographic surgery. A propeller flap was designed, two perforators were identified intraoperatively, microsurgical dissection was performed, and flap rotation was executed. Before and After Patient examination Anterior chest wall defect measuring approximately 8 × 12 cm in diameter with imminent risk of osseous exposure. Pre-operative considerations The reconstructive goals were defined as follows: Provision of durable and stable soft tissue coverage Avoidance of additional donor-site morbidity Prevention of secondary deformity at the donor site 1 Flap Dissection The flap design was planned in this configuration for two reasons: 1) alignment with the anatomical axis of the internal mammary artery perforators; and 2) donor site closure oriented to prevent additional contour deformity. 2 Perforator Selection Perforators were selected based on: 1) palpable Doppler-confirmed pulse; and 2) proximity to the pivot point to allow adequate arc of rotation. 3 Isolated Perforators Following meticulous dissection of the selected perforators, complete flap rotati