Thoraco-Epigastric Flap

Thoracoepigastric flaps are a group of procedures that provide coverage of thoracic defects by pulling up and rotating part of the abdominal skin surface.12 The blood supply of these flaps is situated in the perforating branches of the superior epigastric artery and, depending on the skin surface mobilized, we can define 2 types of thoracoepigastric flaps:

- Thoracoepigastric flap. This is a rotational advancement flap that allows for the skin situated in the lateral regions of the abdomen to be raised up to the thorax. It is mainly indicated in the coverage of mastectomies in which the largest defect is situated laterally toward the axilla. The vascular support of this flap is provided by the perforating branches of the superior epigastric artery, although during dissection some posterior intercostal perforating branches may be preserved. The design involves making an incision that is begun at the lowest lateral portion of the defect and extends to the area of the anterior superior iliac spine. Like bilateral advancement flaps, dissection is done at the fascial plane in a medial and downward direction, during which we preserve some perforating branches that will contribute to the viability of the flap.

- Axial thoracoepigastric flap. (see Case Report) This is a limited variety of the thoracoepigastric flap that circumscribes the angiosome that depends on the sixth perforating branch of the internal thoracic artery, providing a skin surface for the coverage of the lower-inner quadrant of the breast. As it is an axial flap, the length-to width ratio should not be greater than 2:1. Unlike the flaps described up to now, the main use of this flap is in conservative surgery, whether to reconstruct the lower-inner quadrant after excision of a tumor with cutaneous involvement or to resolve local complications due to skin necrosis. In selected cases, it can be used for skin coverage in areas of necrosis after skinpreserving mastectomy, especially when it occurs at the lower pole. (see Video)

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