Management of posterior trunk defects.

LEARNING
OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss nomenclature and anatomy associated with reconstruction of the back. 2. Perform preoperative assessment, decision making, and counseling of patients. 3. Describe current surgical planning, including careful analysis of the defect and appropriate selection of tissue to provide coverage while maximizing form and function.
BACKGROUND: The plastic surgeon is called to reconstruct defects in the posterior truck that involve an extensive zone of injury. Simple solutions, such as wide undermining and primary closure, will not result in a stable closed wound. Successful closure of these wounds depends on preoperative evaluation of tissue needs and host defects, and selection of the most appropriate flap to close dead space and provide vascularized tissue to the wound bed.
METHODS: The authors examined the literature regarding the available treatment options surrounding reconstruction of posterior back wounds. They review the important details surrounding the use of each flap and present select cases from their own experience regarding reconstruction of the back.
RESULTS: : The posterior trunk benefits from multiple flaps that can be used in reconstruction of the back. The wound must be evaluated in terms of tissue requirements and host issues, such as infection or previous radiation. Most wounds can be closed in a single stage, after careful flap section based on the wound's needs and anatomic location, with minimal postoperative complications. Early and aggressive treatment of these wounds improves patient outcomes and can reduce the time spent in hospital.
CONCLUSIONS: Reconstruction of the posterior trunk depends on careful analysis of the tissue defects, host issues, and application of functional anatomy. The majority of wounds can be reconstructed after thorough débridement with a vascularized muscle flap.