Lateral Intercostal Perforator Flap Letter Response
I appreciate the clarification of terminology by Sjoberg and de Weerd, as well as their succinct review of earlier significant contributions, such as the lateral thoracodorsal flap described by Holmstrom et al, not cited in our article.
The redundant lateral chest fold frequently present after mastectomy represents an attractive donor site which is still too often overlooked as a second tier option in breast reconstruction. Whether described as Holmstrom’s lateral thoracodorsal or more recently as the lateral intercostal perforator flap, the skin and fat of this soft tissue fold can be reliably rotated 180 degrees as an axial flap based on robust cutaneous perforators, which arise from the intercostal vessels. A simple 6- to 8-cm skin pedicle centered near the mid-axillary line contains perforators sufficient to supply a surprisingly elongated flap, without the need for muscle or microsurgical dissection. Because the flap is dissected superficial to muscle fascia and follows the natural skin fold, it is easily performed in the outpatient setting with low donor site morbidity. The disadvantages are occasional flap tip necrosis and excess bulk at the pedicle pivot point in the lateral chest. Both problems are typically correctable with a minor revision surgery.