DEFINE AXIAL FLAP. DESCRIBE HOW DO YOU RAISE DELTOPECTORAL FLAP?

An axial flaps are flaps based on named artero-venous pedicle that runs within the skin superficial to underlying muscle layer, parallel to the overlying skin.

DELTOPECTORAL FLAP:

• It is a distant axial flap.
• It was first described by Bakamjian and Littlewood. So The deltopectoral (DP) flap is also called by some as the Bakamjian flap.
• It is an axial pattern flap designed on the anterior chest wall between the line of clavicle and the level of anterior axillary fold.
• VASCULAR SUPPLY: It is supplied by upper 3 or 4 perforating branches of the internal mammary artery. It emerges through the medial end of intercostal spaces.
• BOUNDARIES: 

-Superiorly: Clavicle

-Laterally: Acronium

-Inferiorly: A line running through the anterior axillary fold to above the nipple inferiorly.

• The flap can extend to any site of the neck and occasionally upto the level of zygoma. This flexibility is due to:

1. Ability to retract from side to side after it has been elevated.
2. Anomalous pivot point that is due to considerable laxity of the skin on the anterior axillary fold with abducted arm and thus lower border of flap is longer than upper part.

KEY POINTS DURING PROCEDURE OF RAISING DP FLAP:

• While raising the flap it should not be extended beyond the deltopectoral groove because it results on failure of the tip of the flap.
• Elevation has to begin laterally and the pectoral fascia is left on the flap, leaving the muscle fibre below absolutely bare.
• While elevating the flap if any branches of acrominothoracic axis is encountered it should be ligated.
• Diathermy must be used judiciously.
• When raising the flap the retraction should be upward applied by an assistant using skin hook and precaution should be taken to avoid buttonholing.
• The pivot point on the flap is thus at the medial end of the upper limit and not the lower limit.
• The donor site is usually covered with a split skin graft.

USES OF DELTOPECTORAL FLAP:

1. Allows one stage reconstruction of the anterior neck skin.
2. To reconstruct the defect by passing as a bridge over the normal skin.
3. To reconstruct the large defect of the lower face and the upper neck.
4. May be used in repair of pharyngeal fistula

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