Reconstruction of a Posterior Trunk Defect using a Pedicled Dorsolateral Posterior Intercostal Artery Perforator Flap

Im ag es IMAGES area [2]. Various regional musculocutaneous flaps have played an important role in reconstruction of the posterior trunk [1,2]. However, they have shortcomings of sacrificing underlying muscle and donor site morbidity. Perforator flaps have recently been regarded as a good method for reconstruction of such defects [3,4]. Flap extendibility and less invasiveness without sacrifice of the underlying muscles have proven that pedicled perforator flap is a useful reconstructive option in these areas [3,4]. Prasad et al. [5] proposed the vascular anatomy of dorsolateral musculocutaneous perforators of the posterior intercostals artery (PICA). We experienced a case of pedicled dorsolateral PICA perforator V-Y advancement flap for resurfacing of the posterior trunk defect. Therefore, we report our experience and the results. A 59-year-old male with a 10-year history of diabetes and hypertension was transferred to our department. He visited our hospital with a rapidly progressing mid thoracic abscess. First, incision and drainage was performed in another department, however, soft tissue necrosis occurred. A dark colored necrosis measuring 7 × 6.5 cm in size was observed on the upper and mid-thoracic area (Fig. 1). Debridement, antibiotic therapy, and wound care were initiated. After achieving control of the infection, we performed a one-stage reconstruction using pedicled perforator flap with a freestyle concept. After debridement, the defect measured 18 × 14 cm in size (Fig. 2). Hand held Doppler was used to map the perforator. Using 3.5 × loupe magnification, careful suprafascial