Reconstruction of Posterior Trunk Defects Following Sarcoma Excisions-A Dual-Center Experience

Sarcomas are malignancies of mesodermal origin that have a propensity for aggressive invasion of local structures and hematogenous spread. Sarcomas of the posterior trunk are problematic because of their insidious growth, lack of patient realization, and proximity to the vertebral column and spinal cord. Reconstruction often requires well-vascularized tissue that can withstand the demands of radiotherapy, without significant complications.

We assessed the outcomes of 47 patients over a 7-year period with soft-tissue sarcomas of the posterior trunk extending from the neck to the sacrum and their reconstructions. Nine were direct closures, and 2 required split-thickness skin grafts. Thirty-seven patients underwent 39 flap reconstructions (26 myocutaneous, 12 fasciocutaneous, 1 muscle-only). Thirty-five patients required a single flap reconstruction, and 2 required multiple flaps.

There were no recorded flap failures. Thirty-three patients (70%) healed without complications. Twenty-one patients required radiotherapy (preoperative 3, postoperative 18) and wound healing complications occurred in one (33%) and 5 (27%%) patients, respectively. Complications: seroma (10%), dehiscence (12.8%), return to theater (12.8%), infection (12.8%), and partial flap necrosis (10%). No statistical significance was found when comparing sex, smoking status, diabetes, defect location, or radiotherapy exposure with wound complication outcomes. There was no statistical significance when comparing wound complications, return to theater or healing time between those who had received preoperative and postoperative radiotherapy.

Patients with posterior trunk sarcomas often require well-vascularized robust reconstruction that can withstand the potential complications of radiotherapy and pressure. Reconstruction can include fasciocutaneous or musculocutaneous flaps, or a combination of both, to help reduce morbidity.