Posterior intercostal artery perforator flap for posterior trunk reconstruction: Perforator mapping with high-resolution ultrasound and clinical application

Background: Pedicled perforator flaps have progressively been used for reconstructive purposes of the anterior trunk. However, reports regarding perforator flaps for local reconstruction of the posterior trunk are sparse. The aim of this study was to investigate the vascular basis of perforator flaps based on the posterior intercostal arteries and to highlight the clinical versatility of these flaps for local posterior trunk reconstruction. Methods: The posterior intercostal artery perforators (PICAP) between the 4th and 12th intercostal space were investigated using high resolution ultrasound in ten healthy volunteers. The location, diameter, suprafascial length and course of the individual perforators was measured. PICAP flaps were used in a series of ten cases for defect reconstruction of the posterior trunk to demonstrate their clinical versatility. Results: A total number of 100 perforators was investigated. The mean diameter was 0,7 ± 0,24 mm with an average length until arborisation of 0,8 ± 0,8 cm. Perforators were located at 2,4 ± 1,8 cm from the midline on average. Only 16% of all measured perforators were identified as major perforators (diameter ≥ 1 mm). In ten patients (mean age at surgery 61,7 years, f:m = 3:7) a PICAP flap was used for defect reconstruction at the back with a mean follow-up of 2,9 years. Flap dimensions ranged from 7 × 3 to 16 × 7 cm. In three cases, a complication was observed (one seroma, one hematoma, one marginal tip necrosis). Conclusion: In the present study, a reliable vascular basis of the posterior intercostal artery perforator flap could be demonstrated. Clinically these flaps replace “like with like” and may be transposed in a propeller – or V to Y – fashion. The donor site can be closed primarily in most cases, thus resulting in a favorable donor side morbidity.