[Pedicled Perforator-based Flaps for Reconstruction of Trunk Wall Defects]

The management of trunk wall defects can be a challenge in surgical practice, especially when conventional methods such as primary wound closure or skin grafts are insufficient due to the size and depth of the defect, its location, location, or lack of adequate skin and soft tissue coverage. In recent years, perforator-based local flaps have emerged as a modern, muscle-sparing alternative to traditional local myocutaneous or free microsurgical flaps. Particularly in the back region, suitable recipient vessels for free flaps are often unavailable due to vascular anatomy. At the same time, compared to conventional random-pattern flaps, perforator-based flaps offer increased reliability, as they are based on targeted vascular perforators. This allows them to be designed beyond the classic 2:1 length-to-width ratio and enables greater reach with improved perfusion. By utilising perforating vessels, functionally important musculature can largely be preserved, which may lead to reduced postoperative morbidity and faster rehabilitation.This article is aimed at surgically active colleagues without specialised training in plastic-reconstructive surgery who are nonetheless regularly confronted with complex wound situations-for example, following tumour resections, chronic infections, pressure ulcers, or postoperative wound healing disorders. The goal is to provide a practical overview of the principles, indications, and limitations of perforator-based local flaps. In addition to an introduction to the underlying vascular anatomy (angiosome and perforasome theory), preoperative diagnostic procedures, various flap techniques, and typical clinical courses-including potential surgical complications-are presented.A particular focus is placed on the selection of appropriate flap types based on defect location and the presence of local perforators, with the goal of achieving the simplest, safest, and most sustainable soft tissue coverage possible. Clinical case examples illustrate operative approaches in different regions of the trunk wall.