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The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study

Carrasco-López, Cristian M.D.; Julian Ibañez, Juan Francisco M.D., Ph.D.; Vilà, Jordi M.D., Ph.D.; Rodriguez-Baeza, Alfonso M.D., Ph.D.; Carrera-Burgaya, Anna Ph.D.; Reina-de-la-Torre, Francisco Ph.D.; Damaso-Margelí-Cervera, Victor M.D.; Fernandez-Llamazares-Rodriguez, Jaime Ph.D.; Higueras-Suñe, Carmen M.D., Ph.D.

Plastic & Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 613e–619e
doi: 10.1097/PRS.0000000000003058
Breast: Original Articles

Background: Reconstruction of the anterior thorax is complex because of the presence of aesthetically important areas such as the breast, sternum, and upper abdomen. For this reason, a wide variety of pedicled perforator flaps have been described. The anterior intercostal perforator flap is one of these perforators flaps and is valuable for use in breast reconstruction surgery.

Methods: The location and characteristics of the anterior intercostal perforators were evaluated both anatomically and radiologically. The anatomical study was conducted in a set of 14 hemitrunk cadavers, and the radiologic study was performed retrospectively from a randomly selected set of images obtained from 30 female patients who underwent thoracic computed tomographic angiography for other health problems at the authors’ institution during the year 2015. The findings were then compared.

Results: A total of 60 perforators in 14 hemitrunks were identified and mapped. Perforators were found in all hemithoraces. The lateral third donor location was the most reliable zone, containing larger and more numerous perforators compared with the other donor regions. According to the radiologic study, a total of 164 perforators in 30 computed tomographic angiographs were identified and mapped. Perforators were found in all thoraxes.

Conclusions: The authors found that the intercostal perforator flap has a consistent vascularization. Computed tomographic angiography is less reliable than dissection in identifying the number of perforators. The authors’ findings suggest that intercostal perforator flaps are reliable and consistent flaps for reconstruction of the upper trunk.

Barcelona and Girona, Spain

From the Plastic and General Surgery Departments, Hospital Germans Trias i Pujol, Departament de Ciències Morfològiques, Facultat de Medicina, Universitat Autonoma de Barcelona; and the Anatomical Department, Universitat de Girona.

Received for publication July 28, 2016; accepted September 2, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Cristian Carrasco-López, M.D., Francesc màcia, 26 1 1a 08921, Santa Coloma de Gramanet, Barcelona, Spain, carralo@gmail.com

©2017American Society of Plastic Surgeons