Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: Clinical experience on 20 consecutive oncological cases

Brunetti, Beniamino; Tenna, Stefania; Aveta, Achille; Poccia, Igor; Segreto, Francesco; Cerbone, Vincenzo; Persichetti, Paolo

doi:10.1002/micr.22408

Cited by 26 publications

(20 citation statements)

References 26 publications

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“…According to Prasad et al, maximum flap dimension of perforator flaps from the paraspinal (DICAP) region might be up to 40 × 15 cm (15). Similar studies, even if based on smaller series, report the use of paraspinal flaps to cover posterior trunk defects (16,17). Their overall flap complication rate ranged between 0% and 42.8%, including all types of complications (major and minor together).…”

Section: Discussionmentioning

confidence: 96%

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Summa¹,

Largo²,

Ismail³

et al. 2019

In Vivo

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Background/Aim: Reconstruction of spinal soft tissue defects is challenging, especially when neural structures or prosthetic material are exposed. They should be covered with well-vascularized tissue such as paraspinal perforator flaps. Materials and Methods: This is a retrospective study of soft tissue reconstructions with paraspinal perforator flaps from 2011 to 2018. The technique is described and risk factors for poor wound healing were assessed. Postoperative complications are reported. Results: Twenty patients with a mean age of 63.65 years were included. Defects had an average size of 47 cm 2 and were mainly located in the lumbosacral region (9 patients). Twelve patients suffered from infection following spinal stabilization, seven of whom were diagnosed with osteomyelitis, two patients presented with pressure sore and one patient experienced wound dehiscence. One partial flap necrosis with a lumbar defect occurred, which required revision surgery. No total flap loss occurred. Stable, closed wounds were achieved at their final follow-up. Conclusion: Perforator paraspinal flaps are suitable for immediate reconstruction of spinal defects.

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Section: Discussionmentioning

confidence: 96%

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Summa¹,

Largo²,

Ismail³

et al. 2019

In Vivo

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show abstract

“…Many anatomical variations can exist in this region and a preoperative Doppler is highly recommended for localization of the perforator. Its reported clinical uses include post-tumor excision coverage (neurofibroma, sarcoma, melanoma, and cutaneous carcinoma), closure of myelomeningocele, coverage of exposed spinal hardware, and pressure sore coverage [12–16].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a dorsal thoracic wall defect with a dorsal intercostal artery perforator flap after removal of a bulky cutaneous squamous cell carcinoma: a case report

et al. 2019

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Introduction Surgical reconstruction of large soft tissue defects of the upper back is challenging. Although the usefulness of free perforator flaps has been demonstrated, local options remain limited. The dorsal intercostal artery perforator flap was recently described but its use is still uncommon. Case report An 88-year-old Causasian woman presented with a large, ulcerated, left prescapular cutaneous squamous cell carcinoma (T3N0M0). Complete excision was performed, and the resulting defect was reconstructed with a dorsal intercostal artery perforator flap based on two perforators. Postoperative recovery was uncomplicated and adjuvant radiotherapy commenced 10 weeks later. Conclusion Compared to conventional muscle flaps, the dorsal intercostal artery perforator flap offers greater protection of muscle function, is less invasive, and lowers donor site morbidity. Based on these advantages, this flap should be considered a useful local option for reconstructing large cutaneous defects of the upper back.

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“…We prefer propeller flaps to the advancement flaps or "perforator plus" peninsular design proposed by Brunetti et al (2016). Propellers offer a greater arc of rotation with a partial closure of the donor site secured by the proximal tip, conferring the same benefits in terms of advancement and transposition as their counterparts without the formation of "dog ear" puckering after donor site closure.…”

Section: Casementioning

confidence: 99%

Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects

et al. 2020

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Background Propeller flaps have been reported to cover cervicothoracic midline defects with lower donor site morbidity compared to muscle flaps. When these defects are extensive, we propose a propeller flap technique that we have named dorsal intercostal artery perforator plus (DICAP+) flap based on two perforator pedicles, to secure the large skin paddle. In this article, we present our experience. Methods Six propeller DICAP+ flap procedures were performed on five patients, to reconstruct cervicothoracic midline defects. Three of them were caused by tumors and two were secondary to hardware exposure after spinal surgery. Defect sizes ranged from 16 × 5 to 24 × 9 cm. Every propeller flap was harvested on two perforators including one DICAP, and rotated from 80° to 180°. Results Skin ellipse size ranged from 15 × 7 cm or 82.4 cm2 to 25 × 12 cm or 235.5 cm2, equal to a mean surface area of 160 cm2. The donor site was closed by primary suturing in four of the six procedures, by a contralateral propeller DICAP flap in one patient, and was left to heal by secondary intention in another one. All six flaps successfully covered the underlying defects with no evidence of partial or complete necrosis. No other complications were observed at recipient and donor sites. The follow‐up period ranged from 9 months to 2 years. Conclusions Propeller flaps based on two dorsal perforators including one dorsal intercostal artery perforator, DICAP+, are a reliable means of reconstructing extensive cervicothoracic midline defects.

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Posterior trunk reconstruction with the dorsal intercostal artery perforator based flap: Clinical experience on 20 consecutive oncological cases

Abstract: DICAP based flaps proved to be a reliable option to resurface posterior trunk defects following oncological resection, allowing to achieve like-with-like reconstruction with excellent contour and minimal donor-site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 36:546-551, 2016.

Cited by 26 publications

References 26 publications

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Reconstruction of Spinal Soft Tissue Defects With Perforator Flaps From the Paraspinal Region

Reconstruction of a dorsal thoracic wall defect with a dorsal intercostal artery perforator flap after removal of a bulky cutaneous squamous cell carcinoma: a case report

Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects

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