Figure 2 | Scientific Reports

Figure 2

From: A New Pedicled Internal Mammary Osteomyocutaneous Chimeric Flap (PIMOC) for Salvage Head and Neck Reconstruction: Anatomic Study and Clinical Application

Figure 2

PIMOC surgical technique. (A) Exposure of the mediastinum through an inverted L sternotomy incision and dissection of the IMA pedicle (blue arrow). The VRAM (1) is supplied by the DSEA (yellow arrow). The osteomyocutaneous component (2) contains the 7th rib (*) in this case and is supplied by both the musculophrenic and intercostal arteries (green arrow). (B) Rotation of the PIMOC cephalad. The pivot point of the IMA pedicle is at the lower margin of the first rib (white arrow). (C) Flap inset. The IMA pedicle positioned within the loose subcutaneous tissue at least 3 cm from the tracheostomy site (black arrow). The rib osteomyocutaneous component was used for reconstruction of the mandible and oral lining, and the VRAM component was used for external coverage.

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