Anatomy and Embryology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
World J Surg Oncol. 2022 Jul 28;20(1):244. doi: 10.1186/s12957-022-02711-1.
Posterior intercostal arteries perforators (PICAPs) and lateral intercostal arteries perforators (LICAPs) are great vascular pedicles. Between the 4th and 11th spaces, they arise from the thoracic aorta. These are large perforators that can be the basis of many flaps. Yet, these perforators are underrated as they are poorly studied and scarcely utilized in plastic reconstructions.
Twenty (ten males and ten females) adult cadaveric dissections were done on both sides to study the types, locations, and sizes of posterior intercostal perforators to help design flaps based on them in the best possible way. Perforators were assigned into one of 3 topographical zones of the back (medial, intermediate, and lateral).
The skin of the back was divided into 3 vertical zones: medial, intermediate, and lateral. Posterior intercostal arteries perforators (PICAPs) were found in the medial and intermediate zones. Medial zone PICAPs were large and appeared at the medial border of erector spinae (Es). Intermediate zone PICAPs appeared at the lateral border of Es and passed through latissimus dorsi (Ld) before reaching the skin. Lateral zone perforators were branches of lateral intercostal arteries and were divided into 2 types: (1) posterior branches of lateral intercostal perforators: simply named posterior lateral perforators (PLs); they were small and present in most of the spaces, and (2) anterior branches of lateral intercostal perforators (LICAPs): they were large, dominant pedicles and were found mainly in the 4th to the 7th spaces.
PICAPs and LICAPs are constant and of enormous size and run for a great distance in the skin. They can be utilized as any type of flap.
后肋间动脉穿支（PICAP）和外侧肋间动脉穿支（LICAP）是重要的血管蒂。它们发自胸主动脉，在第 4 至 11 肋间隙之间，这些是较大的穿支，可以作为许多皮瓣的基础。然而，这些穿支由于研究不足且在整形重建中很少使用，因此被低估了。
对 20 具（10 名男性和 10 名女性）成人尸体的两侧进行了解剖，以研究后肋间穿支的类型、位置和大小，以便根据它们设计最佳的皮瓣。穿支被分为背部的 3 个解剖区域（内侧、中间和外侧）之一。
背部皮肤被分为 3 个垂直区域：内侧、中间和外侧。后肋间动脉穿支（PICAP）存在于内侧和中间区域。内侧区域的 PICAP 较大，出现在竖脊肌（Es）的内侧缘。中间区域的 PICAP 出现在 Es 的外侧缘，穿过背阔肌（Ld）后到达皮肤。外侧区域的穿支是外侧肋间动脉的分支，可分为 2 种类型：（1）外侧肋间穿支的后支：简单地称为后侧外侧穿支（PLs）；它们较小，存在于大多数间隙中，（2）外侧肋间穿支的前支（LICAPs）：它们较大，是主要的蒂，主要存在于第 4 至第 7 肋间隙。
PICAP 和 LICAP 是恒定的，且具有巨大的尺寸和在皮肤中长距离运行的特点。它们可以作为任何类型的皮瓣使用。
