The subcostal artery perforator flap; an anatomical study

Area of Science:

• Anatomy
• Plastic Surgery
• Reconstructive Surgery

Background:

• Previous case report highlighted pedicled subcostal artery perforator flap for lumbar defect closure.
• Need for detailed anatomical investigation to assess broader clinical applicability.

Purpose of the Study:

• To investigate the anatomy of the subcostal artery perforator flap.
• To evaluate its potential for wider clinical use in defect coverage.

Main Methods:

• Dissection of 28 subcostal artery perforator flaps in 14 human cadavers.
• Charting perforator location against anatomical landmarks and measuring calibre, pedicle length, and flap size.
• Comparison with Doppler sonography findings in 15 volunteers for in vivo validation.

Main Results:

• Consistent presence of the subcostal artery perforator (mean calibre 2mm) in all specimens and volunteers.
• Constant perforator location identified at the lateral border of the latissimus dorsi muscle, 1-3 cm below the lower rib.
• Mean pedicle length of 10.5 cm and mean flap size of 10 x 14 cm demonstrated, with in vivo confirmation of location.

Conclusions:

• The subcostal artery perforator flap possesses a constant and reliable anatomy, indicating significant potential for lumbar defect coverage.
• Doppler sonography is a valuable tool for preoperative assessment of perforator size and position, aiding in optimal flap design.