Reconstruction of trunk soft-tissue defect using the propeller flaps based on the perforators of the posterior intercostal artery

Objective: To explore the feasibility and technical tips of the posterior intercostal artery perforator (PICAP) flaps for trunk defect reconstruction.

Methods: The PICAPs were thoroughly explored with the hand-held ultrasound Doppler.According to the size,shape and location of the defect,a perforator flap was raised based on the chosen PICAP,rotated in a certain degree and used to reconstruct the torso defect.

Results: From October 2009 to October 2015,22 patients underwent defect reconstruction using the PICAP propeller flaps.The chosen perforators derived from the vertebral segments of the posterior intercostal arteries in 2 patients,from costal groove segments in 15,from intermuscular segments in 4,and from subcostal artery in 1.The skin paddle dimension ranged from 12 cm × 4 cm-30 cm × 10 cm.The length of the perforator pedicle was 3.5-7.0 cm (average 4.8 cm).The flaps were rotated 180° in 15 patients,150° in 4 patients,and 90° in 3 patients.19 flaps survived completely.Distal partial flap necrosis occurred in two flaps and total flap necrosis in one.All wounds at donor sites were closed directly.The patients were followed up for 1 to 5 years (average 3.5 years) with satisfactory outcomes and no tumor recurrence.

Conclusions: The PICAP propeller flap provides a valuable option for different torso defects reconstruction.