Where is the standard site for harvesting the left internal mammary artery (LIMA), and what precaution reduces the risk of sternal devascularization and wound complications?

• A. Chest wall near the left intercostal vessels with careful skeletonization or pedicled harvest to reduce sternal devascularization and wound complications.
• B. Right chest wall near the left intercostal vessels with pedicled harvest to preserve sternal blood supply.
• C. LIMA should be harvested from the femoral region for better stability.
• D. Only skeletonized harvest without any pedicled technique.

Answer: (A)

The left internal mammary artery runs along the inside of the left chest wall, just lateral to the sternum and near the intercostal vessels. So the standard harvesting site is the chest wall on the left, close to those intercostal vessels.

To minimize sternal devascularization and wound complications, the artery is harvested with techniques that preserve blood supply to the sternum. This is most effectively done by carefully skeletonizing the LIMA—dissecting the artery free from surrounding tissue while preserving the key perforating branches to the sternum. A pedicled harvest, performed with meticulous technique to preserve those connections, can also reduce risk. Both approaches aim to maintain chest wall perfusion and prevent wound issues.

The other options misstate the location (not the right chest wall or the femoral region) and the technique (restricting to skeletonization only ignores the valid role of careful pedicled harvest).