Investigation of the dorsolateral branch of the posterior intercostal artery for use as the pedicle of a free flap: A cadaveric study and case series

Abstract

Background The dorsolateral branch of the posterior intercostal artery (DLBPI) can be easily found while harvesting a latissimus dorsi (LD) musculocutaneous flap for breast reconstruction. However, it remains unknown whether this branch can be used for a free flap and whether this branch alone can provide perfusion to the skin. We examined whether the DLBPI could be reliably found and whether it could provide sufficient perfusion. Methods We dissected 10 fresh cadavers and counted DLBPIs with a diameter larger than 2 mm. For each DLBPI, the following parameters were measured: distance from the lateral margin of the LD muscle, level of the intercostal space, distance from the spinal process, and distance from the inferior angle of the scapula. Results The DLBPI was easily found in all cadavers and was reliably located in the specified area. The average number of DLBPIs was 1.65. They were located between the seventh and eleventh intercostal spaces. The average length of the DLBPI between the intercostal space and the LD muscle was 4.82 cm. To assess the perfusion of the DLBPIs, a lead oxide mixture was injected through the branch and observed using X-rays, and it showed good perfusion. Conclusions The DLBPI can be used as a pedicle in free flaps for small defects. DLBPI flaps have some limitations, such as a short pedicle. However, an advantage of this branch is that it can be reliably located through simple dissection. For women, it has the advantage of concealing the donor scar underneath the bra band.

Posterior intercostal flap: an anatomical study and best flap design

“…Nam et al [ 11 ] used PICAP as a free flap for breast reconstruction overcoming the scar issue after thoracodorsal artery perforator (TDAP) flap. They documented that it was found between the 7th and 11th intercostal spaces.…”

“…Prasad et al [ 7 ] described unnamed musculocutaneous perforators that are intermediate in position between PICAPs and LICAPs and proposed to call them dorsolateral branches of PICA. Nam et al [ 11 ] used the dorsolateral or posterolateral perforators (PLs) as a free flap to cover defects in distant sites as the face and leg.…”