Pre-expanded Intercostal Perforator Super-Thin Skin Flap

This article introduces pre-expanded super-thin intercostal perforator flaps, particularly the flap that has a perforator from the first to second intercostal spaces. The key techniques, advantages and disadvantages, and complications and management of this flap are described. At present, the thinnest possible flap is achieved by thinning the pre-expanded flap that has a perforator from the first to second intercostal spaces. It is used to reconstruct large defects on the face and neck, thus restoring function and cosmetic appearance.

Key points

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When the intercostal perforator flap is thinned after expansion, it is slightly thicker than a full thickness skin graft and can be used to repair face and neck defects, thereby simultaneously restoring function and cosmetic appearance.
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Its benefits include a surgical delay after expansion, which allows the flap to be trimmed into a thinner flap while avoiding necrosis and reducing the risk of long- and short-term skin contracture.
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Pre-expanded intercostal perforators enhance the blood flow of the flap and yields a flap with an above-average length-to-width ratio. However, it is a time-consuming three-stage procedure that is difficult for elderly patients and patients with cervical problems.