Arch Plast Surg.  2014 Jan;41(1):50-56. 10.5999/aps.2014.41.1.50.

Face Reconstruction Using Lateral Intercostal Artery Perforator-Based Adipofascial Free Flap

  • 1Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 2Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 3Department of Anatomy, Keio University College of Medicine, Tokyo, Japan.
  • 4Ischemic/Hypoxic Disease Institute Seoul National University College of Medicine, Seoul, Korea.


The aim of this study was to determine the efficacy of lateral intercostal artery perforator-based adipofascial free flaps for facial reconstruction in patients with facial soft tissue deficiency.
We conducted a retrospective study of five consecutive patients diagnosed with facial soft tissue deficiency who underwent operations between July 2006 and November 2011. Flap design included the area containing the perforators. A linear incision was made along the rib, which had the main intercostal pedicle. First, we dissected below Scarpa's fascia as the dorsal limit of the flap. Then, the adipofascial flap was elevated from the medial to the lateral side, including the perforator that pierces the serratus anterior muscle after emerging from the lateral intercostal artery. After confirming the location of the perforator, pedicle dissection was performed dorsally.
Dominant perforators were located on the sixth to eighth intercostal space, and more than four perforators were found in fresh-cadaver angiography. In the clinical case series, the seventh or eighth intercostal artery perforators were used for the free flaps. The mean diameter of the pedicle artery was 1.36 mm, and the mean pedicle length was 61.4 mm. There was one case of partial fat necrosis. No severe complications occurred.
This is the first study of facial contour reconstruction using lateral intercostal artery perforator-based adipofascial free flaps. The use of this type of flap was effective and can be considered a good alternative for restoring facial symmetry in patients with severe facial soft tissue deficiency.


Perforator flap; Free tissue flaps; Face

MeSH Terms

Fat Necrosis
Free Tissue Flaps*
Perforator Flap
Retrospective Studies
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