{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T10:19:15Z","timestamp":1786875555961,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T00:00:00Z","timestamp":1589587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Propeller flaps have been reported to cover cervicothoracic midline defects with lower donor site morbidity compared to muscle flaps. When these defects are extensive, we propose a propeller flap technique that we have named dorsal intercostal artery perforator plus (DICAP+) flap based on two perforator pedicles, to secure the large skin paddle. In this article, we present our experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Six propeller DICAP+ flap procedures were performed on five patients, to reconstruct cervicothoracic midline defects. Three of them were caused by tumors and two were secondary to hardware exposure after spinal surgery. Defect sizes ranged from 16 \u00d7\u20095 to 24 \u00d7\u20099 cm. Every propeller flap was harvested on two perforators including one DICAP, and rotated from 80\u00b0 to 180\u00b0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Skin ellipse size ranged from 15 \u00d7\u20097 cm or 82.4 cm<jats:sup>2<\/jats:sup> to 25 \u00d7\u200912\u2009cm or 235.5 cm<jats:sup>2<\/jats:sup>, equal to a mean surface area of 160\u2009cm<jats:sup>2<\/jats:sup>. The donor site was closed by primary suturing in four of the six procedures, by a contralateral propeller DICAP flap in one patient, and was left to heal by secondary intention in another one. All six flaps successfully covered the underlying defects with no evidence of partial or complete necrosis. No other complications were observed at recipient and donor sites. The follow\u2010up period ranged from 9 months to 2\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Propeller flaps based on two dorsal perforators including one dorsal intercostal artery perforator, DICAP+, are a reliable means of reconstructing extensive cervicothoracic midline defects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30595","type":"journal-article","created":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T15:11:53Z","timestamp":1589641913000},"page":"656-662","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Bipedicled dorsal intercostal artery propeller flaps for reconstruction of extensive cervicothoracic midline defects"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5374-5159","authenticated-orcid":false,"given":"Magali","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarra","family":"Cristofari","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"},{"name":"Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Al Madani","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golda","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1618-6033","authenticated-orcid":false,"given":"Quentin","family":"Qassemyar","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"},{"name":"Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugues","family":"Pascal\u2010Moussellard","sequence":"additional","affiliation":[{"name":"Sorbonne University  Paris France"},{"name":"Department of Orthopedic Surgery and Traumatology Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Atlan","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Esthetic Surgery Tenon Hospital, Sorbonne University  Paris France"},{"name":"Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000263452.23901.ba"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198401000-00003"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30098"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22408"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.2002.3791"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31819537b4"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/2000656X.2015.1102737"},{"key":"e_1_2_6_9_1","first-page":"359","volume-title":"Perforator flaps: Anatomy, technique and clinical applications","author":"Geddes C. 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