IMAP Flap—A New Option for Head and Neck Reconstruction
Bibliographic record
Abstract
This paper presented the authors' experience with the internal mammary artery perforator (IMAP) flap. It has evolved as a progression from the deltopectoral flap and other similar flaps previously described. It is based on the perforators of the internal mammary artery and combines our current understanding of cutaneous arterial anatomy and physiology with the classic deltopectoral flap. Careful dissection of the perforator and mobilization of the internal mammary vessels by costal cartilage resection allow rotation of the flap to cover defects in the neck and clavicular area. Dissection and perfusion studies were performed in 5 fresh cadavers to detail the anatomy and to establish the safe limits of the IMAP flap. The dominant perforator is inconstant and varies from side to side and between patients. The area reliably perfused by any one perforator is large and extends from the clavicle to the xiphisternum, and the anterior axillary line to the mid-line. Greatest flap length can be obtained by orienting the flap obliquely across the chest. Clinical cases were discussed individually. To date, these have included oblique flaps for neck resurfacing, and vertical flaps for pharyngeal reconstruction and parastomal repair. The IMAP flap provides good quality local tissue which can be made sensate. It will safely reach to the jaw line and is suitable for a variety of reconstructive uses. In selected patients, it offers an excellent alternative to either the deltopectoral or pectoralis major flaps.
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".