Background: Primary closure of chest wall and epigastric defects is often difficult. Many muscle and musculocutaneous flaps have been described for management of these challenging wounds. Intercostal artery perforator island flaps have been previously described in the literature, mostly for reconstruction of inferior pole breast defects or upper back defects. However, they are not commonly used for reconstruction of anterior midline torso defects.

Methods: We present a retrospective review of the presentation, management, and outcomes of 6 consecutive cases of intercostal artery perforator flaps. We describe the indications, basic anatomical planning, and surgical procedure in a series of 6 consecutive patients who underwent intercostal artery perforator flap creation. The series of 6 patients consists of 5 females and 1 male. All 5 female patients required coverage of anterior chest wall defects resulting from resection of breast cancer and subsequent partial failure of TRAM or latissimus dorsi flaps complicated with postradiation changes. The male patient required coverage of an epigastric defect with an exposed left ventricular assist device (LVAD).

Results: Follow up for all patients ranged from 9 months to 3 years. Reconstructive efforts were successful in all patients. There was no flap loss in the series. Two patients did have superficial epidermolysis, which responded to treatment with local wound care; no surgical debridement was necessary.

Conclusions: Based on our successful experience, we believe that the intercostal artery perforator island flap can be used primarily to cover defects of the ipsilateral and contralateral chest wall and upper abdomen. It is also a reliable salvage flap for reconstructing difficult chest wall and epigastric defects.