The deltopectoral flap
This is a skin flap raised on the anterior chest wall, with its base over the sternum and its distal portion extending out to the front of the shoulder (see Figure 118). It is supplied by perforating branches of the internal mammary artery. This flap may be raised, tubed and stitched into defects in the neck and face up to the level of the zygoma. As with all axial flaps, the transposition is a two-stage procedure. After the flap has been stitched into its recipient site, it must be left in continuity for three weeks to allow the skin at the recipient site to gain a local blood supply. The pedicle of the flap connecting it to its donor site may then be divided and the remnant returned to the original site, while the part of the flap in use is then stitched in to complete the filling of the defect. The donor site is covered by a skin graft and part of this is then removed when the pedicle is returned to its place of origin. At one time the deltopectoral flap was used to reconstruct the pharynx after removal of tumours, but this staged procedure is no longer necessary as alternative methods of repair have evolved. The deltopectoral flap may still be used, however, to fill certain skin defects.