Arch Hand Microsurg.  2021 Mar;26(1):63-67. 10.12790/ahm.20.0068.

Propeller Dorsal Intercostal Artery Perforator Flap for an Extensive Defect on the Back Following Malignant Peripheral Nerve Sheath Tumor Resection: A Case Report

• Song SH
• Kwon H
• Kim S
• Kim JH
• Kyung HW
• Oh SH
• Yang HJ
• Ha Y

• KMID: 2513208
• DOI: http://doi.org/10.12790/ahm.20.0068

Abstract

Posterior trunk defects have been a challenging anatomical area to cover in reconstructive surgery. The use of local myocutaneous flaps has been described extensively in the literature to cover these defects, but these techniques are associated with significant donor-site morbidity, including functional loss of muscle units. Freestyle perforator flaps enable local tissue recruitment with skin of a similar color and texture in diverse anatomic areas, but there is a shortage of case series on posterior trunk defects using propeller dorsal intercostal artery perforator (DICAP) flaps, particularly when the defects are extensive. In this report, the authors present a successful case of a DICAP propeller flap for an extensive defect on the upper back following a malignant peripheral nerve sheath tumor resection.

Keyword

Perforator flap; Neoplasms; Reconstructive surgical procedures

Figure

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  Fig. 1. A 70-year-old female with a malignant peripheral nerve sheath tumor measuring 20×15×10 cm3 was present on the left upper back.

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  Fig. 2. Wound defect after wide local excision of malignant peripheral nerve sheath tumor that measured 25×20 cm2. A 30×18-cm2 propeller dorsal intercostal artery perforator flap was designed to close the defect based on the 6th posterior intercostal artery.

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  Fig. 3. The 6th posterior intercostal artery was identified using an exploratory incision adjacent to the defect. Red circles, preoperative localization of the posterior intercostal artery perforators using a hand-held Doppler; red dotted line, the course of the vessel loop around the 6th posterior intercostal artery under the flap; yellow line, the midline; orange shaded area, the elevated flap area.

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  Fig. 4. Immediate postoperative appearance.

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  Fig. 5. Postoperative appearance at 6 months. (A) At rest. (B) Bilateral arms abduction.

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