Versatility of Intercostal Artery Perforator Flaps

Pedicled intercostal perforator flaps have not been reported in the literature. The authors' experience with these flaps for different indications was demonstrated.

The intercostal vessels form an arcade between the aorta and the internal mammary vessels. Different sensate perforator pedicled flaps can be raised on this neurovascular bundle to cover defects over the trunk.

Between 2001 and 2003, 14 intercostal perforator pedicled flaps were harvested in 10 patients. The indications were bilateral autologous breast augmentation in 4 patients who underwent bariatric surgery; immediate partial breast reconstruction in 4 patients who had a quadrantectomy for breast cancer; midline back and sternal defects in 2 patients who had radical excisions for dermatofibrosarcoma. The average flap dimensions were 16 × 8 cm (range: 12 × 6 to 22 × 11 cm). All flaps were based on one perforator. Total flap survival was reported.

The intercostal perforator flaps provide valuable options in breast surgery and for challenging defects on the trunk. Harvesting these flaps without sacrifice of the underlying muscle not only means reduced donor-site morbidity, but also a longer vascular pedicle and more freedom in composing and tailoring the flap.