A novel salvage approach for pedicle axial flap-free-ization of pedicle internal mammary artery perforator flap

A pedicle flap with distal segment compromise is classically managed by allowing tissue demarcation, debridement of non-viable tissue, and local tissue manipulation to achieve wound closure. When aggressive debridement leaves insufficient tissue for defect coverage, the original flap is often discarded. We present a case of distal necrosis of a pedicle internal mammary artery perforator flap for cheek reconstruction. The flap, which was rendered too small after debridement for defect coverage in its pedicle form, was converted to a free flap. The technical details of such conversion and potential feasibility of applying this conversion to other compromised pedicle flaps are discussed. We hypothesized that the principle of "free-ization" can be applied effectively for salvage of other failing pedicle flaps with axial blood supply.