The IMAP Flap: A Natural Evolution
Bibliographic record
Abstract
An improved understanding of vascular anatomy has led to the description of new flaps and affords a greater choice in reconstructive options. Flaps that were formerly workhorses have in some cases been relegated to second line or have been dropped completely from the armamentarium. The deltopectoral (DP) flap was introduced by Bakamjian in 1965 and was quickly adopted by surgeons all over the world as an excellent option in head and neck reconstruction. The unsightly donor defect, as well as the advent of more sophisticated flaps, has led to a decline in its use. However, the DP flap is, in many ways, still a very attractive option. This paper described early experience with the internal mammary artery perforator (IMAP) flap. To date, it has been used for neck resurfacing, as well as for pharyngo-esophageal reconstruction. The flap is based on one or multiple perforator vessels from the internal mammary artery. Mobilization of the flap involves resection of the intervening costal cartilage(s) in order to expose the internal mammary. This vessel is divided distally and mobilized. The flap can be pedicled up into the neck. It can also be used as a free flap, which further increases its potential applications. Unlike the DP flap, the IMAP flap donor site can be closed directly and, as with all perforator flaps, the skin paddle can be placed over the perforating vessels in such a way as to optimize both flap tissue and donor site. Clinical applications as well as harvest techniques were described.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".