Extended locoregional use of intercostal artery perforator propeller flaps

Abstract

Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk.

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

“…The intercostal arteries are defined as having dorsal, lateral, and anterior cutaneous perforators (Hamdi et al, 2006). Pedicled lateral ICAP flaps are used widely in oncoplastic breast surgery, and in trunk reconstruction (Baghaki et al, 2017; Hamdi et al, 2006).…”

Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects

“…Propellers offer a greater arc of rotation with a partial closure of the donor site secured by the proximal tip, conferring the same benefits in terms of advancement and transposition as their counterparts without the formation of "dog ear" puckering after donor site closure. Baghaki et al (2017) published the largest case series to date, numbering a total of 52 ICAP flaps, 19 of which were DICAP flaps.…”

Propeller Dorsal Intercostal Artery Perforator Flap for an Extensive Defect on the Back Following Malignant Peripheral Nerve Sheath Tumor Resection: A Case Report

“…The application of perforator flap technique enables long and reliable vascular pedicles, thinner flaps with minimal donor-site morbidity and without including muscle tissue [6]. Intercostal artery perforator flaps have been used widely to cover the diverse trunk defects, based on an understanding of the anatomy of intercostal vessels [7][8][9][10][11][12]. Among them, dorsal intercostal artery perforator (DICAP) flaps have recently been described in posterior trunk reconstruction [13][14][15][16][17].…”