Perforating vessel as an alternative option of a recipient selection for posterior trunk-free flap reconstruction

The reconstruction of complex defects in the posterior trunk is a challenging problem. Various surgical methods using local flap, propeller flap, and muscle flap have been reported. However, in case where a free flap is inevitable, due to the absence of usable recipient vessels, eventually it may fail to perform or the use of long vessel graft is mandatory. To overcome this problem, we investigated use of perforator as recipient vessel in posterior trunk region and here we report satisfactory outcomes of the cases.

Eighteen cases with posterior trunk defects underwent reconstruction surgeries using various free flaps. Perforating vessels, from either the base or margin of the defect, were evaluated by preoperative computed tomography and hand-held Doppler. During the dissection, preoperatively marked perforators, with visual healthy pulsation and appropriate diameter for anastomosis, were selected and used for a recipient vessel for free flap.

Perforating vessels from the posterior trunk (0.8-1.3 mm in diameter) were used as recipient vessels and the average size of the defect was 85.2 cm² . In all cases, one artery and vein was used for anastomosis. No flap necrosis occurred. Hematoma developed in one case and partial wound disruption developed in 2 cases.

Surgical method using perforators as recipients for free flap reconstruction can be one of a good treatment option for posterior trunk reconstruction. We think that microsurgeons need not to hesitate when they use perforating vessel as a recipient vessel.