The island anterior intercostal artery perforator flap as another option for the difficult epigastric abdominal wound

Closure of the epigastric or upper abdominal wound can be challenging even with traditional flap options. If those are unavailable due to prior surgical or anatomic constraints, a local muscle perforator flap based on the anterior intercostal artery (AICA) may be another available option if a vascularized flap is mandatory. Caution must be observed as the perforators of the AICA are diminutive, and the dissection can be tedious. Nevertheless, in 2 clinical cases, the anterior intercostal artery perforator (AICAP) flap was successfully used as an island pedicled flap to close a difficult subxiphoid wound, proving a secondary role for this donor site as a potential alternative selection.