Lateral Thoracodorsal Flap or Lateral Intercostal Artery Perforator Flap: What Is in the Name?

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Dear Sir:
We read with interest the article by Hakakian et al1 on the use of the lateral intercostal artery perforator (LICAP) flap in breast reconstruction and congratulate them with their results.
Although not referenced by the authors, Holmström et al2 described this flap already in 1986. They too acknowledged the surplus of skin and adipose tissue on the lateral thorax and designed the so-called lateral thoracodorsal (LTD) flap to create a larger subcutaneous pocket in delayed implant breast reconstructions without total muscle coverage. Similar to the LTD flap, the blood supply to the LICAP flap relies on perforators from the lateral intercostal artery. In accordance with the new standard nomenclature for muscle perforator flaps, initiated in Gent in 2001 and further developed thereafter, the appropriate naming of the LTD flap should therefore be the LICAP flap.3
Similar to Hakakian et al., Holmström et al. used a simplified skin bridge pedicle without microsurgical perforator dissection. More recently, the use of this skin bridge pedicle LTD flap has been reported in oncoplastic breast surgery and in postbariatric mastopexy procedures to provide tissue volume.4,5 Woerdeman et al6 described their experience with the LTD flap in implant breast reconstructions. As in the study by Hakakian and Hage et al,7 the most common complication was tip necrosis, which was more likely to occur with a flap length of more than 17 cm. de Weerd et al8 described their modification of the flap design and acknowledged the simplicity of the technique. We have used the LTD flap in secondary implant breast reconstructions and reported its value as a salvage procedure for partial flap loss in free abdominal flap breast reconstruction. It is our experience that the resulting scars are well tolerated by the patients, who often appraise the aesthetic improvement of the lateral chest wall. Even so, we agree with Hudson9 that the skin bridge pedicle of the flap may create a box form appearance of the reconstructed breast.
The LTD flap and the simplified skin bridge pedicled LICAP flap have the same blood supply and so the principal idea is the same. However, it appears to us that Hakakian et al through this article have demonstrated a valuable modification to the work of Holmström et al, because they did not include the underlying muscular fascia. Such may lead to less donor site morbidity. We thank Hakakian et al for their interesting article on this useful flap in breast reconstruction.
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