Clinical Application of Free-style Perforator-based Stepladder V-Y Advancement Flap for Repair of Small- to Medium-sized Wound Defects of the Posterior Trunk.

BACKGROUND

Back wounds can be caused by trauma, infection, or tumor resection and are potentially associated with exposure of muscles and dead space. Due to the thick and inelastic nature of the skin on the back, these wounds usually cannot be closed directly, and skin grafts or flap reconstruction are often necessary. This study aimed to investigate the clinical application of a free-style perforator-based stepladder V-Y advancement flap in the repair of small- to medium-sized wound defects in the posterior trunk.

METHODS

Anatomical studies were performed on lateral thoracodorsal cadaver specimens to characterize the location, diameter, and alignment of the perforators of the circumflex scapular artery, dorsal scapular artery, and posterior intercostal artery. Then, from January 2016 to December 2021, these perforating branches were clinically applied to design and perform free-style perforator-based stepladder V-Y advancement flaps for the reconstruction of small- to medium-sized back wounds.

RESULTS

Twelve patients with skin and soft tissue defects of the back underwent free-style perforator-based stepladder V-Y advancement flaps. The defect area ranged from 5.5 × 5.0 cm to 9.5 × 8.5 cm, and the flap area ranged from 11.0 × 6.0 cm to 21.0 × 10.0 cm. All donor sites were closed with multilayered suturing. The survival rate of the flaps was 100%. One patient developed flap tip necrosis, which was successfully treated with daily dressing changes. All flaps achieved adequate and durable reconstruction with excellent contouring during follow-up, ranging from 8 to 12 months.

CONCLUSIONS

The free-style perforator-based stepladder V-Y advancement flap is a safe and reliable method for repairing small- to medium-sized defects of the posterior trunk. This local flap is a well-vascularized, sensate, and pliable option, and the appearance of the flap is morphologically and functionally sound.