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Skin Perforators of Back Region: Anatomical Study and Clinical Applications

Atik, Bekir MD*; Tan, Onder MD; Mutaf, Mehmet MD; Senel, Berna MD§; Yilmaz, Nebi MD; Kiymaz, Nejmi MD

doi: 10.1097/
Original Article

Background: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region.

Materials and Methods: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap.

Results: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases.

Conclusion: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.

From the *Department of Plastic and Reconstructive Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey; †Department of Plastic and Reconstructive Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey; ‡Department of Plastic and Reconstructive Surgery, Medical Faculty, Gaziantep University, Gaziantep, Turkey; §Istanbul Forensic Medicine Institution, Istanbul, Turkey; and ¶Department of Neurosurgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey.

Received January 25, 2007, and accepted for publication, after revision, February 16, 2007.

Reprints: Bekir Atik, MD, Yuzuncu Yil Universitesi Tip Fakultesi, Plastik Ve Rekonstruktif Cerrahi A.D., 65100 – Van, Turkey. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.