The relevant distribution of the blood vessels originating from the thoracoacromial artery and the technique used to raise the pectoralis major myocutaneous island flap are described. The nutrient vessel to this flap is the thoracoacromial artery and its pectoral branches. After giving off its axillary vessels this artery with its vein crosses the upper edge of the pectoralis minor muscle and passes between the pectoralis major and minor muscles. There its branches extend over an area bordered by the second and sixth rib and the mammary and parasternal lines. The skin underlying this area is supplied by branches of the internal mammary artery and on its deep surface by branches of the thoracoacromial artery. Preservation of the thoracoacromial vein as well as artery is also necessary in this creation of a viable pectoralis major myocutaneous island flap.

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