The number of intercostal artery perforators over the distal latissimus dorsi muscle

Abstract

With the increasing popularity of perforator flaps as "musculocutaneous flaps without muscle," a new interest in the intercostal vessels as source vessels for perforator flaps has arisen. In a recent study, the branches of the three lowermost intercostal vessels to the latissimus dorsi were studied in detail. Now that these muscular branches are well understood, the present study examines how many of these branches reach the overlying skin as musculocutaneous perforators. We identified the intercostal artery perforators in the ninth, tenth, and eleventh interspaces, in 42 hemithoraces. Only branches that measured 0.5 mm or more in external diameter were included. The course of the perforators was followed from their exit from the latissimus dorsi muscle up to the entrance at the undersurface of the skin. This entrance point was punctured by a pin and thus marked on the skin. This study showed that at least three musculocutaneous perforators were present over the intercostal spaces IX-XI in every dorsal hemithorax (average 8 +/- 3, range 3-16). Potentially, each of these vessels can be used as a pedicle for a separate perforator flap, leaving the more proximal parts of the latissimus dorsi intact for a second flap based on the dominant thoracodorsal vessels.

Extended locoregional use of intercostal artery perforator propeller flaps

“…Anatomy of anterior and posterior intercostal arteries is well defined (Beer & Manestar, ; Hamdi et al, ; Prasad, Almutairi, Kimble, Stewart, & Morris, ). Trunk can be divided into three basic zones of perforators: parasternal, lateral costal and paravertebral.…”

Regarding the vascular anatomy of muscles with a special focus on the gracilis muscle

“…The recent years, studies in clinical anatomy have produced valuable information on specific vascularization of the anatomical structures used in these flaps (Saadeh et al, 1998;Fróes et al, 1999;Traxler et al, 1999;Tao et al, 2000;Halim and Wan, 2004;Macchi et al, 2008Macchi et al, , 2009Rozen et al, 2008Rozen et al, , 2009Rozen et al, , 2010Rozen et al, , 2011Ger, 2009;Ma et al, 2009;Papadimas et al, 2009;Beer and Manestar, 2010;Piquilloud et al, 2011;Janus et al, 2012).…”