The Lateral Intercostal Artery Perforators: Anatomical Study and Clinical Application in Breast Surgery

Background: The lateral intercostal artery perforator flaps are based on intercostal perforators that arise from the costal groove. Cadaver dissections have been performed to improve the understanding of lateral intercostal perforator anatomy. The clinical applications of this study are demonstrated. Methods: The intercostal perforators were dissected in 24 fresh cadavers and evaluated in a field that extended between the third and the eighth intercostal spaces and between the latissimus dorsi and pectoralis major muscles. Their relationship with the anterior border of the latissimus dorsi muscle and the serratus anterior vessels was investigated. Results: A mean value of 3.91 perforators per side was found. The majority of the intercostal perforators were found between the fifth and the eighth intercostal space level (88.4 percent). Mean distances of intercostal perforators to the anterior border of the latissimus dorsi muscle varied between 2.67 and 3.49 cm. The largest or "dominant" perforator was most frequently found in the sixth intercostal space (38.6 percent of cases) at an average of 2.5 to 3.5 cm from the anterior border of the latissimus dorsi muscle. In 10 of 47 sides (21 percent), vascular connections were found between the serratus anterior branch and the intercostal perforators. The connection was observed more frequently in the seventh and the sixth intercostal spaces, in 38 percent and 30 percent of cases, respectively. This vascular connection enables harvest of a serratus anterior artery perforator flap. Conclusion: Lateral intercostal artery perforator flaps can be used to address challenging defects over the breast without sacrificing the pedicle of the latissimus dorsi muscle.