{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:50:22Z","timestamp":1775044222280,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The reported complications' rate of perforator propeller flaps is variably high, but the etiology of distal flap necrosis, potentially linked to vascular insufficiency, is yet to be clarified. Vascular augmentation procedures have been previously described involving an extra anastomosis of a superficial vein, while a perforator\u2010to\u2010perforator supercharging approach has been only sporadically documented in literature. We present a case of perforator\u2010to\u2010perforator vascular supercharging of an extended dorsal intercostal artery perforator (DICAP) propeller flap to provide a salvage option for pedicled flap complicated by venous congestion. A 71\u2010year\u2010old male patient underwent Dermatofibrosarcoma Protuberans resection in the upper back, leading to a 17\u2009\u00d7\u200917\u2009cm defect with bone exposure. A 30\u2009\u00d7\u20099\u2009cm DICAP propeller flap was planned, with the distal third of the flap designed over the adjacent Thoracodorsal artery perforasome, in a conjoined fashion. Considering the small DICAP pedicle caliber and the flap lateral extension, a thoracodorsal artery perforator vein was dissected and included in the distal flap. Once the flap was raised on its main pedicle, the skin paddle turned blue, showing signs of venous insufficiency. Indocyanine green angiography (ICG) showed a viable proximal half of the flap. Hence, after rotating the skin paddle to reach the upper margin of the defect, an additional anastomosis between the perforating thoracodorsal vein and the perforating vein of the dorsal scapular pedicle was performed according to the perforator\u2010to\u2010perforator approach. Doing so, both clinical and ICG examinations showed a well perfused flap, with normal capillary refill. The postoperative course was uneventful, and the patient obtained a good oncological and reconstructive result 4\u2009months postoperatively. The second Vasconez law (\u201call of the flap will survive except the part that you need\u201d) is often encountered in propeller flaps surgery. Our case shows that it is possible to prevent or overcome this problem by planning appropriate vascular augmentation procedures according to the perforator\u2010to\u2010perforator approach, being guided by advanced vascular imaging tools like ICG.<\/jats:p>","DOI":"10.1002\/micr.31129","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T07:29:16Z","timestamp":1698218956000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Conjoined thoracodorsal perforator\u2010supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps"],"prefix":"10.1002","volume":"44","author":[{"given":"Beniamino","family":"Brunetti","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Salzillo","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"De Bernardis","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Tenna","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Camilloni","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8857-6060","authenticated-orcid":false,"given":"Paolo","family":"Persichetti","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200011000-00009"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30728"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22408"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1714087"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30162"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199809020-00074"},{"issue":"4","key":"e_1_2_5_8_1","article-title":"Supercharging and augmenting venous drainage of an anterolateral thigh free flap: Options and indications","volume":"2","author":"Deleyiannis F. W.\u2010B.","year":"2014","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.09.013"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318254b128"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.08.061"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22380"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2016.03.015"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31110"},{"key":"e_1_2_5_15_1","first-page":"11","volume-title":"Perforator flaps: Anatomy, technique & clinical applications","author":"Morris S.","year":"2006"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318244230b"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31824a9f76"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22039"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30595"},{"issue":"4","key":"e_1_2_5_20_1","first-page":"351","article-title":"Propeller flaps: A literature review","volume":"30","author":"Sisti A.","year":"2016","journal-title":"In Vivo"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000193542.02193.f2"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30734"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31009"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0160942"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T11:56:54Z","timestamp":1707393414000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,25]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1002\/micr.31129"],"URL":"https:\/\/doi.org\/10.1002\/micr.31129","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,25]]},"assertion":[{"value":"2023-05-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31129"}}