Freestyle multiple propeller flap reconstruction (jigsaw puzzle approach) for complicated back defects

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Wound Healing

Background:

• Posterior trunk defects present reconstruction challenges due to size, dead space, and exposed hardware.
• Achieving tension-free closure for extensive posterior trunk defects is difficult.

Purpose of the Study:

• To achieve tension-free closure for complex posterior trunk defects.
• To evaluate a novel flap combination technique for posterior trunk reconstruction.

Main Methods:

• A freestyle approach combining multiple propeller flaps (single or multilobed) with adjacent random pattern flaps was used.
• 18 cases of posterior trunk defects were reconstructed between August 2006 and May 2013.
• The technique involved a jigsaw puzzle-like arrangement of flaps for defect coverage.

Main Results:

• The average defect size was 139.6 cm² (range, 36-345 cm²).
• A total of 26 perforator flaps and 19 random pattern flaps were utilized across 18 cases.
• All reconstructions resulted in tension-free closure of both the defect and donor sites, with 100% success and no flap loss. One late infection occurred.

Conclusions:

• Combining multilobed propeller flaps with random pattern flaps in a freestyle approach allows for tension-free closure of extensive posterior trunk defects.
• This technique effectively obliterates dead space and ensures reliable vascularity without oversizing flaps.
• The jigsaw puzzle-like flap arrangement offers a viable solution for complex posterior trunk reconstruction.