Objective To explore the clinical application of internal mammary artery perforator （IMAP） propeller flap in

the repairing of anterior chest wall wounds. Methods A retrospective analysis was conducted on 16 cases who underwent the internal mammary artery perforator （IMAP） flap surgery for chest wall defect reconstruction in our department between January 2021 and September 2024. Etiologies included tumor resection （4 cases）， keloid excision （9 cases）， and ulceration （3 cases）. All patients underwent preoperative handheld Doppler ultrasound along with either digital subtraction angiography （DSA） or computed tomography angiography （CTA） to identify the locations of IMA perforators and determine the dominant perforator， thereby guiding perforator selection and flap design. For cases with anticipated large defects where the donor site could not be closed directly， primary tissue expansion was performed at the donor site. IMAP propeller flaps were utilized in all cases， with all donor sites successfully closed directly by layered suture. Patients with keloids received routine postoperative radiotherapy and additional anti-scarring therapy. Results In this series， the IMAP1 flap was utilized in 2 cases， the IMAP2 flap in 12 cases， and the IMAP3 flap in 2 cases. Of these，3 patients underwent tissue expander implantation， with flap transfer completed in a second-stage procedure. All flaps survived completely， and the donor site incisions healed well. Patients were followed up for 6 months to 2 years， with no bserved recurrence of tumors or keloids. Conclusion IMAP flap is a promising option for reconstructing chest wall defects. Preoperative Doppler ultrasound， DSA， and CTA provide valuable guidance for identifying IMA perforator locations， selecting the dominant perforator， and planning individualized flap design.

Anterior chest wall wound, Internal mammary artery perforator flap, Angiography, Doppler ultrasonography