Perforator-Based Flaps for Defect Reconstruction of the Posterior Trunk

Area of Science:

• Plastic surgery
• Reconstructive surgery
• Microsurgery

Background:

• Full-thickness soft tissue defects of the back present significant challenges for reconstructive surgeons.
• Perforator-based local flaps are increasingly favored for their versatility in reconstruction.
• A lack of decision-making algorithms and heterogeneous patient cohorts complicate flap selection.

Purpose of the Study:

• To evaluate the efficacy and outcomes of local perforator-based flaps for soft tissue reconstruction of the posterior trunk.
• To analyze decision-making processes and flap choices in reconstructive surgery for back defects.
• To assess complications and functional outcomes associated with different perforator flap techniques.

Main Methods:

• Retrospective evaluation of patients undergoing local perforator-based soft tissue reconstruction between 2012 and 2019.
• Data analysis included flap type, dimensions, wound characteristics, operative time, complications, and hospitalization duration.
• Focus on reconstructive techniques and flap selection for defect closure.

Main Results:

• Forty perforator-based local flaps were used in 36 patients (mean age 56.3 years) for posterior trunk defects.
• Propeller flaps (PPFs) constituted 70% and perforator-based VY-advancement flaps (P-VYFs) 30% of reconstructions.
• Revision surgery was needed in 25% of cases due to complications like hematoma, infection, and flap loss.

Conclusions:

• Pedicled perforator flaps are reliable for reconstructing complex posterior trunk wounds.
• A flexible surgical strategy considering individual perforator anatomy is crucial for successful reconstruction.
• Local perforator flaps, including P-VYFs and PPFs, provide sustainable reconstruction with minimal donor site morbidity.