Double Free Style Perforator Propeller Flaps for Large Posterior Trunk Defects Post Sarcoma Excision

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Reconstructive Surgery

Background:

• Large posterior trunk defects often result from radical sarcoma excisions.
• Conventional reconstruction methods like free flaps or local flaps have limitations, especially with adjuvant radiotherapy.
• Perforator flaps, particularly double perforator flaps, are emerging as effective solutions for extensive defects.

Purpose of the Study:

• To evaluate the efficacy and safety of double perforator flaps for reconstructing large posterior trunk defects.
• To assess complications and tolerance to postoperative radiation therapy.
• To compare double perforator flaps with conventional free flap reconstructions.

Main Methods:

• A retrospective analysis of consecutive double perforator flaps used for posterior trunk defects.
• Detailed recording of defect size, flap design, perforator origin, and complications.
• Assessment of flap survival, venous/arterial issues, need for secondary procedures, and radiation tolerance.

Main Results:

• Twenty-four double perforator flaps were performed in 12 patients with an average defect size of 168.5 cm².
• One flap was lost due to arterial issues; two experienced venous insufficiency requiring intervention.
• Postoperative radiation therapy was generally well-tolerated, with minimal donor site morbidity due to primary closure.

Conclusions:

• Double perforator flaps represent a viable and effective alternative to free flaps for large posterior trunk defects.
• This technique effectively utilizes the native vascular supply and abundant local tissue.
• Primary donor site closure minimizes complications and morbidity, making it a favorable reconstructive option.