The posterior intercostal artery (PICA) is divided into four segments, vertebral, costal, intermuscular, and rectus, based on the neurovascular branching pattern. Dorsal branches arise from the vertebral segment. Several musculocutaneous perforators and a lateral branch originate from the costal segment. Musculocutaneous branches arise from the intermuscular and rectus segments. The purpose of this study is to describe in detail the musculocutaneous perforators of the costal segment of the posterior intercostal artery.
Fresh cadavers were injected with a modified lead oxide–gelatin mixture. Intercostal spaces (8–11) were dissected in twelve cadavers (six preserved cadavers and six fresh cadavers). Angiograms were assembled with Adobe Photoshop. Two fresh cadavers underwent CT angiography and three dimensional reconstructions of the intercostal perforators were performed using Materialise's Interactive Medical Image Control System (MIMICS).
In twelve cadavers, a total of 356 perforators (size > 0.5 mm) were found to arise from the posterior intercostal arteries in 96 intercostal (IC) spaces. 154 perforators (>0.5 mm) were found in the costal segment of the PICA. An average of 6.4 perforators was found in each hemithorax. All perforators were found within 2 cm of the midscapular line. At least one perforator was found in all intercostal spaces. Two or more perforators were found in 40% of the 8th and 9th IC spaces and 60% of the 10th and 11th IC spaces. Perforators were oriented perpendicular to the direction of the muscle fibres of the latissimus dorsi and were usually present one or two intercostal spaces below their origin from the PICA.
Perforators of the costal segment of the PICA are described in detail. We propose to call these currently unnamed musculocutaneous perforators “dorsolateral” branches of the PICA, as they are located between dorsal and lateral branches of PICA.
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- Churchill Livingstone, London1989 Gray's anatomy. 37th ed.
- Churchill-Livingstone, Edinburgh1994 The arterial anatomy of skin flaps. 2nd ed.
- Use of a long island flap to bring sensation to the sacral area in young paraplegics.Plast Reconstr Surg. 1974; 54: 220-223
- The great potential of the intercostal flap for torso reconstruction.Plast Reconstr Surg. 1978; 61: 653-665
- The intercostal flap: an anatomical and hemodynamic approach.Ann Plast Surg. 1979; 2: 411-421
- Die Hautdeterides Menschlichen Korpers.FCW Vogel, Leipzig1889
- Arteres de lPeau.Masson et Cie, Paris1936
- The angiosomes of the body and their supply to perforator flaps.Clin Plast Surg. 2003; 30 (v): 331-342
- The lateral intercostal neurovascular free flap.Plast Reconstr Surg. 1984; 73: 17-26
- Inadvertent free intercostal artery perforator flaps.J Plast Reconstr Aesthetic Surg. 2009; 62: e140-e141
- Modified lead oxide-gelatin injection technique for vascular studies.J Clin Anat. 2002; 1: 73-78
- Dorsal intercostal artery perforator flap: anatomical study and clinical applications.Plast Reconstr Surg. 2007; 120: 681-689
- The vascular basis of perforator flaps based on the source arteries of the lateral lumbar region.Plast Reconstr Surg. 2005; 115: 1651-1659
- The bipedicled and bipartite latissimus dorsi free and perforator flap: an anatomic study.Plast Reconstr Surg. 2006; 118: 1162-1170
- The number of intercostal artery perforators over the distal latissimus dorsi muscle.Clin Anat. 2010; 23: 216-221
- The versatility of the inter-costal artery perforator (ICAP) flaps.J Plast Reconstr Aesthetic Surg. 2006; 59: 644-652
Published online: June 11, 2012
Accepted: May 18, 2012
Received: January 18, 2012
☆Presented on October 28, 2010 at the XIIIth International Perforator Flap Meeting, Mexico City, Mexico and on May 26, 2011 at the 16th Congress of the International Confederation for Plastic Reconstructive and Aesthetic Surgery (IPRAS), Vancouver, Canada.
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.