title: The versatility of the inter-costal artery perforator (ICAP) flaps.
abstract: BACKGROUND
  Anatomy and classification of intercostal perforator flaps in addition to our experience with will be demonstrated for different indications.
  
  
  METHODS
  The intercostal vessels form an arcade between the aorta and the internal mammary vessels. Different pedicled perforator flaps can be raised on this neurovascular bundle to cover defects on the trunk. They are classified as following: dorsal intercostal artery perforator flap (DICAP); lateral intercostal artery perforator (LICAP); and anterior intercostal artery perforator (AICAP) flap.
  
  
  RESULTS
  Between 2001 and 2004, 20 pedicled (ICAP) flaps were harvested in 16 patients. The indications were: immediate partial breast reconstruction in eight patients who had a quadrantectomy for breast cancer; midline back and sternal defects in three patients who had radical excisions for a dermatofibrosarcoma or malignant melanoma; and autologous breast augmentation (four bilateral and one unilateral flap) in five post-bariatric-surgery patients. The average flap dimension was 18 x 8 cm(2) (range 8 x 5-24 x 12 cm(2)). There were two DICAP flaps, two (AICAP) flaps and 16 (LICAP) flaps. All but two flaps were based on one perforator. Mean harvesting time was 45min for a single flap. Bilateral breast augmentation with LICAP flap necessitated longer operative time (range 2-3h) depending whether it was combined or not with mastopoexy. Complete flaps survival was obtained. All donor sites were closed primarily.
  
  
  CONCLUSIONS
  The (ICAP) flaps provide valuable options in breast surgery; and for challenging defects on the trunk without sacrifice of the underlying muscle.
authors.affiliation: Plastic Surgery Department, Gent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. moustapha.hamdi@ugent.be
authors.forename: Moustapha
authors.initials: M
authors.lastname: Hamdi
authors.forename: Koenraad
authors.initials: K
authors.lastname: Van Landuyt
authors.forename: Bob
authors.initials: B
authors.lastname: de Frene
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roche
authors.forename: Phillip
authors.initials: P
authors.lastname: Blondeel
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D018223:Dermatofibrosarcoma / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012272:Ribs; D012878:Skin Neoplasms / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply; D013895:Thoracic Arteries / Q000601:surgery*; D013909:Thorax / Q000098:blood supply; D016896:Treatment Outcome