Free flaps for reconstruction of the lower back and sacral area

Free flap reconstruction of the lower back and sacrum is complicated by a p aucity of recipient vessels and difficulties in postoperative care. From 19 83 to 1997, six patients with intractable wounds of the lower back and sacr al area were treated with free flaps. The flaps used were latissimus dorsi (three), combined latissimus dorsi and serratus anterior (one), and fillete d leg tissue (two), The recipient vessels were the deep femoral vessels, th e perforator vessels of the deep femoral system, the inferior epigastric ve ssels, and the superior gluteal and inferior gluteal vessels. The patients were observed in the intensive care unit for 1 week and kept in prone posit ion for 4 weeks. All flaps survived and wounds healed primarily. For large or multiple defects of the lower back and sacrum, free tissue transfer is e ffective in achieving primary healing, particularly when local flaps are in adequate or have failed. (C) 2000 Wiley-Liss, Inc.