Use of the lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap for treatment of antecubital burn contractures Huseyin Karagoz a, *, Fikret Eren b , Ersin Ulkur c a Maresal Cakmak Military Hospital, Department of Plastic and Reconstructive Surgery, Erzurum, Turkey b Etimesgut Military Hospital, Department of Plastic and Reconstructive Surgery, Ankara, Turkey c Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey Flexion contractures are late sequelae that occur with burns of the deep antecubital region. Antecubital defects created by radical excision of scar tissue require good soft tissue coverage due to recurrence of contractures that cannot always be avoided even with proper splinting and therapy, even though they have been traditionally released with the use of skin grafts, if tendons and neurovascular structures are not exposed. In this study, we describe a lateral intercostal artery perforator (LICAP)-based pedicled reverse thoraco-abdominal flap for coverage of the antecubital fossa after releasing contractures of this region in selected cases with limited treatment options. The vascular pedicle of LICAP-based reverse thoraco-abdominal flap has lateral perforators of the posterior intercostal arteries. Nine pairs of posterior intercostal arteries arise from the descending thoracic aorta and are distributed to the lower nine intercostal spaces. The posterior intercostal artery gives off the lateral cutaneous branches (lateral perforators) at the midaxillary line and these branches pierce the external and internal intercostal muscles and give off the anterior and posterior branches [1]. The posterior branches pass backwards horizontally and are distributed in the skin of the back. The anterior branches travel and pass obliquely anteriorly and downward and enter the subcutaneous tissue of the lateral thorax [2]. LICAP-based flaps (using both the anterior [3,4], and posterior branches[5]) have also been used to reconstruct upper extremity defects. We also used the anterior branch of the lateral intercostal artery for nourishment of the flap as did Yunchuan et al. [3] however, at the beginning, we de- burns 37 (2011) 134–138 article info Article history: Received 5 July 2009 Received in revised form 2 March 2010 Accepted 25 March 2010 Keywords: Lateral intercostal artery Perforator flap Reverse thoraco-abdominal flap Antecubital burn contracture abstract We describe a lateral intercostal artery perforator-based pedicled reverse thoraco-abdomi- nal flap for coverage of the antecubital fossa after burn scar release. In this study we describe raising and insetting the flap and reported our clinical results and observations. Antecubital contracture release was carried out in six patients, and the lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap was raised based on the anterolateral cutaneous perforator of the appropriate intercostal artery. The defects were repaired with this flap. All the flaps survived and antecubital contractures were repaired successfully. No recurrent contracture occurred in any of the patients at a mean of 15.3 months. The lateral intercostal artery perforator-based pedicled reverse thoraco-abdominal flap can be used effectively for repair of antecubital tissue defects as an alternative to other reconstructive methods. # 2010 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author at: Maresal Cakmak Asker Hastanesi, Plastik Cerrahi Servisi, 25100 Erzurum, Turkey. Tel.: +90 5325169957. E-mail address: hkaragozmd@hotmail.com (H. Karagoz). available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/burns 0305-4179/$36.00 # 2010 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2010.03.010