A free intercostal artery perforator flap as a salvage operation for a planned lumbar artery perforator flap with aberrant anatomy in breast reconstruction: A case report

Abstract

When autologous breast reconstruction is planned but abdominal tissue is not available, the lumbar artery perforator flap provides an alternative choice with minimal donor site morbidity. The lumbar and posterior intercostal arteries supply adjacent perforasomes on the posterolateral flank. The purpose of this report is to highlight the salvage of an autologous breast reconstruction free flap using a dorsal perforator of the posterior intercostal artery, when the planned lumbar artery perforators were not suitable. The patient was a 74‐year‐old with recurrent left‐sided breast cancer requiring immediate breast reconstruction. A lumbar perforator flap was planned as an oblique ellipse 19 × 10 cm. Intraoperatively, the two identified perforators traveled superiorly up to the 12th rib and therefore originated from the intercostal rather than lumbar arteries. The internal mammary artery and the vena comitants were used as recipient vessels, anastomosed to an interposition graft. Postoperatively, the patient was discharged home after 7 days without complication. Six months later, the patient was pleased with the reconstruction and had negligible donor site morbidity. The dorsal intercostal artery perforator flap therefore provides a salvage option when presumed lumbar artery perforators are dissected and found to be intercostal in origin.

Evaluation of Anterior Intercostal Artery Perforator Flap for Oncoplastic Immediate Reconstruction Following Breast-Conserving Surgery in Lower Breast Quadrants Lesions; an Institutional-Based Study

“…These flaps can be used either as pedicled flaps, [20][21][22] or as free flaps. 23 Despite its usefulness as an oncoplastic reconstructive option following BCS, the AICAP flap is rarely described in the literature, apart from a few case reports. 13,23,24 It is particularly useful in patients with small-sized breasts in whom reduction mammoplasty is considered inappropriate.…”

“…23 Despite its usefulness as an oncoplastic reconstructive option following BCS, the AICAP flap is rarely described in the literature, apart from a few case reports. 13,23,24 It is particularly useful in patients with small-sized breasts in whom reduction mammoplasty is considered inappropriate. The AICAP flaps had several advantages, being reliable, easy to learn, and not needing advanced microsurgical knowledge.…”

Anterior intercostal artery perforator flap for immediate reconstruction following breast conservation surgery

“…Various intercostal artery perforator flaps have been described for oncoplastic flap reconstruction of the breast after BCS, for the most part pedicled (Agrawal et al, 2020 ; Denning et al, 2020 ; Kim et al, 2018 ), but also as a free flap (Sharp et al, 2021 ). The scarcely reported anterior ICAP flap is an attractive reconstructive option after BCS, especially in patients with small breast sizes who are not ideal candidates for more extensive breast reduction techniques.…”

Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis

“…Commonly, used perforator flaps include the anterolateral thigh perforator flap (ALTPF), deep inferior epigastric artery flap (DIEPF), profunda artery perforator flap (PAPF), medial sural artery perforator flap (MSAP), thoracodorsal artery perforator flap (TAPF), and lower medial thigh perforator flap (LMTPF). In recent years, a variety of new perforator flaps have been developed and widely used in clinic, including the posterior tibial artery perforator flap (PTAPF), superior gluteal artery perforator flap (SGAPF), inferior gluteal artery perforator flap (IGAPF), and superficial circumflex iliac artery perforator fascial flap (SCIAPF) (Fritz et al, 2021; Sharp et al, 2021; Sumiya et al, 2021). The DIEPF is widely used in breast reconstruction, ALTPF is considered a horse flap for the reconstruction of head and neck defects, and various flaps are used for the reconstruction of limb defects (Chen et al, 2010; Ito et al, 2016; Sun et al, 2011).…”