The clinical use of perforator flaps has demonstrated that harvesting of flaps on a

single perforator is possible for reconstruction of large defects. We present a 71-year-old male with a lesion on his left mid back that measured 10 × 10 × 4 cm3. Biopsy of the lesion was consistent with dermatofibrosarcoma protruberans. Wide local excision of the lesion with 4 cm margin was performed. The soft tissue defect, ∼20 cm BYL719 ic50 in diameter, was reconstructed with a large propeller dorsal intercostal artery perforator (DICAP) flap. The DICAP flap measured 40 × 15 cm2 based on a single perforator—lateral branch of dorsal rami of the seventh posterior intercostal artery on the right side. The perforator flap was elevated at the subfascial level and transposed 180° into the FDA-approved Drug Library clinical trial defect. The donor site on the right side of the back was closed directly. This case illustrates the size of the propeller DICAP flap that could be safely harvested on a single perforator from the dorsal rami of the posterior intercostal artery. To our knowledge this is the largest reported pedicled perforator flap harvested on a single perforator on the posterior trunk. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. “
“The position of perforator vessels varies between individuals. In this report, we present our experience on the use of combining

multidetector-row computed tomography (MDCT), Doppler flowmetry, and indocyanine green (ICG) fluorescent angiography to identify perforator vessels of flaps for reconstruction. We evaluated the advantages, disadvantages, and chose the necessary examination, depending on characteristics of the flap. The combination of MDCT, Doppler flowmetry, and ICG fluorescent angiography examinations to identify perforators was performed in 50 patients before reconstructive surgery. The patients first underwent MDCT of the prospective flap donor region. Perforators were then marked for this site by using Doppler flowmetry in the neighborhood of the points identified MG-132 in vitro by MDCT. After placing the patient in the intraoperative posture, ICG fluorescent angiography was performed to confirm the intensity and position

of the perforators. In all 50 patients examined by using this approach, perforators were intraoperatively identified near the preoperatively determined sites. Flap harvesting was possible in all patients with the identified perforators as the vascular pedicle. But it was difficult to identify the perforators on the MDCT in the patients who had a flap thickness of less than 8 mm and the identification of the perforators was difficult on ICG fluorescent angiography in the patients with a flap thickness greater than 20 mm. The transferred free flaps survived in all patients without complications. On the basis of the results, selection of the most suitable mode of examination depending on the characteristics of flap is recommended. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.