Freestyle multiple-perforator Island flaps for reconstruction of large dorsolumbar defects: A retrospective case...

Keystone-type fasciocutaneous flaps, derived from the angiosome concept, are island flaps that have demonstrated versatility and reliability in the reconstruction of multiple anatomical regions. However, evidence regarding their use in large dorsolumbar soft-tissue defects remains limited. This study describes clinical outcomes and explores flap design parameters, particularly pedicular area proportions, in this challenging anatomical region.

A retrospective, non-comparative case series was conducted through medical record review of consecutive patients treated between 2021 and 2023. Patients presenting with large soft-tissue defects of the dorsolumbar region who underwent reconstruction using freestyle multiple-perforator island flaps were included. Sociodemographic data, defect characteristics, flap design variables, and postoperative outcomes were extracted and analyzed descriptively.

Twenty-one flaps were performed in 21 patients, with a mean age of 35 years. The mean defect size was 120 cm² (range, 12-353 cm²), and the mean flap size was 283 cm² (range, 27-589 cm²). The mean pedicular area represented 15% of total flap surface. During follow-up, four flaps developed minor wound dehiscence managed conservatively, and one flap presented transient venous congestion. A single case of partial flap loss was observed, with no cases of total flap loss. Notably, flap viability was preserved even in cases with pedicular areas as low as 10%.

In this retrospective series, freestyle multiple-perforator island flaps provided reliable coverage with low complication rates, even with pedicular areas as low as 10-15%, suggesting greater design flexibility than traditionally assumed. These findings support their role as a practical locoregional reconstructive option with limited donor-site morbidity and reduced technical complexity. Further comparative studies are required to validate these observations.