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Sarcoma Defect Reconstruction of the Posterior Trunk With Local Perforator Propeller Flaps.

Daniel Rittirsch^1,2, Xinchen Gu¹, Sophie Ricketts¹

¹Department of Plastic, Reconstructive and Hand Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia.

ANZ Journal of Surgery

|November 29, 2025

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Perforator propeller flaps effectively reconstruct large posterior trunk defects after sarcoma removal. This method offers a safe and reliable solution with excellent patient satisfaction and no functional deficits.

Area of Science:

Plastic Surgery
Surgical Oncology
Reconstructive Surgery

Background:

Large posterior trunk defects post-sarcoma resection pose reconstructive challenges.
Traditional methods like musculocutaneous or free flaps can lead to donor site morbidity and functional deficits.
Locoregional perforator flaps are increasingly utilized for back defects.

Purpose of the Study:

To evaluate the use of various perforator propeller flaps for oncologic reconstruction of large soft tissue defects of the posterior trunk.

Main Methods:

A retrospective study of 23 patients undergoing perforator propeller flap reconstruction between 2014 and 2023.
Defects were located in the cervical, thoracic, lumbar, and sacral regions of the posterior trunk.
Donor sites included posterior intercostal artery, lumbar artery, and superior gluteal artery vascular territories.

Keywords:

microsurgery plastics and reconstructive surgery propeller flap sarcoma

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Main Results:

All perforator propeller flaps (average defect size 166.6 cm²) survived, demonstrating versatility across different trunk regions.
Only two patients required revision surgery for minor complications (hematoma, infected seroma).
Long-term follow-up showed no donor site morbidities or functional deficits, with excellent aesthetic outcomes and high patient satisfaction.

Conclusions:

Perforator flaps are a safe, versatile, and reliable option for resurfacing large posterior trunk defects after oncological resection.
This technique minimizes donor site morbidity and preserves function, offering superior aesthetic results.