Reliability of extended dorsal intercostal artery perforator propeller flaps for reconstruction of large myelomeningocele defects

SummaryReconstruction of large myelomeningocele defects using extended (elongated beyond the lateral margin of the latissimus dorsi muscle) dorsal intercostal artery perforator (DICAP) propeller flaps is not recommended by previous studies. However, to provide tension-free and successful closure of a defect, the DICAP propeller flaps must sometimes be elongated beyond this margin. Our experience and results in this issue are discussed.In this article, reconstruction of 11 consecutive cases, with large myelomeningocele defects in which standard DICAP propeller flaps were incapable to close the defect, was achieved using extended DICAP propeller flaps between June 2013 and November 2015. At least two reliable perforators of the neighboring intervertebral spaces are included to supply the flap. Intramuscular dissection of perforators is performed to free the perforators from the surrounding muscle and to gain pedicle length as much as possible to prevent twisting and vascular compromise.All the flaps survived completely except for one patient who had superficial skin necrosis on the most distal part of the flap and had severe accompanying systemic disorders and died on postoperative 14th day. In 7 of 11 patients, venous congestion was noted, which resolved spontaneously. No hematoma or seroma formation was observed during the postoperative follow-up period.Dissection of multiple DICAPs supplying flaps enable us to harvest larger DICAP flaps possibly by providing better arterial supply and venous drainage. We use microsurgical instruments and 4.3× loupe magnification for pedicle dissection in this newborn population. This study shows the reliability of extended DICAP propeller flaps when multiple perforators at sixth or more cranial adjacent intercostal spaces are included in DICAP propeller flaps.