Delayed Perforator Flaps for Reconstruction of Extensive Defects of the Posterior Trunk

Abstract

ABSTRACT

OBJECTIVES: The delay phenomenon involves neovascularization of tissue after ischemic preconditioning. When employed, the delay phenomenon promotes flap survival and increases length-to-width ratio in conventional flaps. Although well-planned perforator flaps cover defects without tension, the success rate is unpredictable in extensive defects that are closed because of the unknown vascularity of perforasomes. We aimed to increase perforator flap size by utilizing the delay phenomenon for broad defects of posterior trunks. MATERIALS AND METHODS: Between 2019 and 2020, 10 patients (6 female, 4 male) underwent posterior trunk reconstruction with delayed perforator flaps. We retrospectively analyzed etiology, defect size, flap size and type, postoperative complications, and long-term results. The etiology of defects was meningomyelocele, soft tissue sarcoma, and pressure ulcers in 3, 3, and 4 patients, respectively. Defects were covered with delayed lumbar, intercostal, and thoracodorsal perforator flaps. Flaps were planned unilateral or bilaterally. Perforators were located preoperatively with a handheld Doppler. In the first session, delaying incisions and pedicle dissection were performed. The delayed incision was primarily sutured. Perforator flaps were elevated 1 week later, and defects were closed. RESULTS: Mean defect size was 375 cm2, and mean flap size was 420 cm2 (202-625 cm2). The donor site was closed primarily for 7 patients. Two patients required split-thickness skin grafts. One patient had donor site closed with secondary healing. No flap losses among patients were shown. Hematoma was seen in 2 patients in the immediate postoperative period. After 2 weeks, seroma and donor site dehiscence were shown in 2 and 1 patient, respectively. CONCLUSIONS: The delay phenomenon can be utilized in perforator flaps as in random pattern local flaps. Perforasome areas can be extended with delayed incision. In addition, broad defects of the posterior trunk can be safely covered with delayed perforator flaps.