【Introduction】
A large defect demands a large flap to reconstruct it. In addition to the commonly used radial forearm flap, latissimus dorsi flap, rectus abdominis flap, anterolateral thigh flap, a free flap that is derived from an intercostal artery perforator can be also a choice of large-dimension flaps.

【Materials and Methods】
From Dec., 2014 to Feb., 2022, 16 patients underwent free intercostal artery perforator (ICAP) flap to reconstruct the defects caused by varies problems like trauma, orthopedic implant infection, and diabetic foot. The procedures of flap-elevation include sub-fascial dissection and identification of perforators, retrograde isolation of vessels of flap-pedicle underneath ribs, and cutting-off the flap.

【Results】
All (100%) the flaps survived and served their purposes well. There were some minor complications like partial necrosis of flap, wound infection, and minimal pneumothorax, and these needed only conservative treatments. Two flaps needed debulky one year later.

【Discussion】
A free ICAP flap can provide wide skin pedal, subcutaneous fat, and rib. The adjacent intercostal vessels can be chosen for, or all included in, one flap. Thus, the applications of free ICAP flap can be versatile. On the contrary, dissection of flap- pedicle is more difficult than that of other conventional free flaps, and makes the flap less handy and popular.

【Conclusions】
Free ICAP flap can be an alternative method of reconstruction surgery.