Objective To evaluate the feasibility of complete removal of the multifocal and extensive lesions by accurate imaging diagnosis and to repair large skin defects due to complete resection of microcystic LMs using lateral intercostal artery perforator （LICAP） flap. Methods From January 2009 to June 2012, tissue defects in the axillary chest wall region of 8 patients aged from 13 to 22 years after microcystic LMs resections were closed using LICAP flap. Flap donor sites in all patients were closed primarily except one patient who underwent skin grafting. Before surgery, ultrasound and MRI examination were used to confirm the diagnosis and determine the scope and level of the abnormality for complete resection. Results All defects after microcystic LMs excision were successfully closed using LICAP flaps. The follow-up period ranged from 1 to 3 years （mean 2.1 years）. All flaps survived postoperatively. No recurrence occurred. Ultrasound and MRI also demonstrated flap survival without recurrence of microcystic LMs. No functional loss attributable to the LICAP flap harvest was identified. Conclusion Ultrasound and MRI are safe and accurate diagnostic imaging methods for the pre- and post-operative evaluation of the microcystic LMs in patients undergoing surgery. LICAP flap provides good coverage for the large defects and achieves acceptable morphology without functional deficits in donor sites.