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. 2023 May 29;50(3):233-239.
doi: 10.1055/a-2058-7927. eCollection 2023 May.

Clinical Applications of the Intercostal Artery Perforator Flap for Trunk Reconstruction

Young Jun Kim  1 , Woo Young Choi  1 , Ji Seon Cheon  1 , Min Hyub Choi  1
Affiliations

Clinical Applications of the Intercostal Artery Perforator Flap for Trunk Reconstruction

Young Jun Kim et al. Arch Plast Surg. .

Abstract

Background Trunk defects can occur because of surgical site infections after spinal surgery, resection of malignant tumors, or trauma. Herein, we present our experience of using intercostal artery perforator (ICAP) flaps to reconstruct trunk defects without noteworthy complications. Fourteen patients underwent reconstruction with ICAP flaps between March 2015 and March 2019. Methods Patients' data, including age, sex, the cause of the defect, defect size, perforator location, flap size, complications, and follow-up period, were retrospectively reviewed. The mean age of the patients was 56.5 years (range, 19-80 years). All operations were performed after the results of bacterial culture from the wound showed no microbial growth. We found reliable perforators around the defect using Doppler ultrasonography. The perforator flaps were elevated with a pulsatile perforator and rotated in a propeller fashion to the defects. We performed five dorsal and two lateral ICAP flaps. The mean flap dimensions were 12 × 5.5 cm 2 (range, 6 × 5 to 18 × 8 cm 2 ). Results Primary closure of the donor site was performed. Marginal congestion was observed as a complication in one case, but it healed with no need for revision. The mean follow-up period was 8 months. All patients were satisfied with the surgical outcomes. Conclusion ICAP flaps can be easily mobilized, thereby reducing donor site morbidity without sacrificing the underlying muscles for trunk reconstruction. Therefore, these flaps are useful options for the reconstruction of trunk defects.

Keywords: donor site; intercostal artery perforator flap; reconstruction; trunk defects.

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Conflict of interest statement

Conflict of interest None declared.

Figures

Fig
Fig
1 Flap design. The flap was designed with an elliptical shape. ( A ) Long axis of the defect. ( B ) Distance between the perforator and the distal portion of the flap. ( C ) Distance between the perforator and the furthest part of the defect.
Fig
Fig
2 Case 1. ( A ) A 6 cm × 5 cm defect due to surgical site dehiscence after bilateral V-Y advancement flap coverage in a 66-year-old man. A DICAP flap was done in a propeller flap fashion. ( B ) Immediately after surgery, the flap appeared pinkish in color. Doppler findings were normal. ( C ). A healthy wound was noted at a 3-month outpatient follow-up.
Fig. 3
Fig. 3
Case 3. ( A ) A 15 cm × 5 cm defect after surgical debridement. ( B ) Flap inset with DICAP propeller flap coverage. ( C ) A healthy-looking wound 4 months after surgery.
Fig. 4
Fig. 4
Case 6. ( A ) Soft tissue defects on the right lateral chest in a 32-year-old man after the removal of bullets from a gunshot injury (shotgun). ( B ) A LICAP flap on the same side was performed with a split-thickness skin graft on the remaining defect. ( C ) Postoperative image.
Fig. 5
Fig. 5
Case 13. ( A ) Wound dehiscence after posterior thoracic spine fusion in a 20-year-old man. ( B ) DICAP flap coverage. ( C ) A healthy wound at a 6-month outpatient follow-up.
Fig. 6
Fig. 6
Schematic illustration of posterior intercostal artery (PICA), DICAP, and LICAP, representing four segments of the intercostal space: vertebral, costal groove, intermuscular, and rectus. The branches of the PICA that supply DICAP and LICAP flaps are shown. A, aorta; AICA, anterior intercostal artery; DICAP, dorsal intercostal artery perforator; LICAP, lateral intercostal artery perforator; S, sternum; V, vertebra.
See this image and copyright information in PMC

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