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

Large defects of the posterior trunk after soft tissue sarcoma resection represent a challenge in reconstructive surgery. Coverage with musculocutaneous flaps or free flaps is often associated with donor site morbidity and functional deficits. With increasing popularity, the clinical indications of locoregional perforator flaps have been expanded to defects of the back. In the present study, the use of various perforator propeller flaps for oncologic reconstruction of large soft tissue defects of the posterior trunk is evaluated.

Between 2014 and 2023, perforator propeller flaps were performed in 23 patients for reconstruction of large soft tissue defects after sarcoma resection in different regions of the posterior trunk.

Soft tissue defects after wide resection of soft tissue sarcoma of the back comprised the cervical, thoracic, lumbar, and sacral regions. Donor sites included perforator propeller flaps of the posterior intercostal artery, lumbar artery, and superior gluteal artery vascular territories. The dimensions of the soft tissue defects of the flaps were 166.6 ± 17.3 cm². All perforator propeller flaps survived. Revision surgery was required in two patients (partial necrosis of flap tip due to hematoma, n = 1; infected seroma with impaired wound healing, n = 1). During the follow-up (range 6 months-8 8 years) no donor site morbidities or functional deficits were noted. Furthermore, aesthetic results showed excellent contour reconstruction and all patients were satisfied with the surgical outcome.

In our experience, perforator flaps represent a safe, versatile and reliable option to resurface large posterior trunk defects following oncological resection.