[Reconstruction of Complex Trunk Defects Using Pedicled and Free Flaps in Combination with AV Loops]

Large trunk defects occur after extensive oncological resections, trauma, infections or adjuvant radiotherapy and often require complex reconstructions. In the case of multi-layered skin soft tissue defects without the possibility of primary closure, defect coverage using free flaps is necessary if local flap options are exhausted. AV loops can bridge to recipient vessels if local options are limited and are used in combination with free flaps. A plethora of free flaps is available in the armamentarium for defect coverage, which are selected according to the reconstruction required. Common flaps for reconstruction are the perforator-based anterolateral thigh flap (ALT flap), but also muscle-bearing flaps with and without a skin island, such as the latissimus dorsi flap or the vastus lateralis flap. Early interdisciplinary collaboration between different specialist disciplines - with the involvement of plastic-reconstructive surgeons - can enable the closure of critically large defects.