Abstract
Background Reconstruction after wide resection of a large sarcoma arising in the posterior trunk
may require free-flap transfer to reduce the postoperative complications. Here, we
describe the recipient vessels on the whole posterior trunk. Moreover, to show the
reliability of these vessels, we describe an institutional series of free-flap reconstruction.
Methods In the cadaveric study, 20 posterior trunk regions from 10 fixed cadavers were dissected.
The location and the diameter of the perforating artery and vein on the posterior
were documented. In the clinical study, 54 patients undergoing immediate reconstruction
surgery with only a pedicled flap (n = 45) and with a free flap (n = 9) after sarcoma resection on the posterior trunk between July 2005 and September
2021 were identified. One-to-one propensity score matching was performed to compare
the postoperative complications.
Results In the cadaveric study, a total of 178 perforators were identified. The average diameter
of the superficial cervical artery (SCA) and vein, dorsal scapular artery (DSA) and
vein, medial branch of dorsal intercostal artery perforator (m-DICAP) and vein, lateral
branch of dorsal intercostal artery perforator (l-DICAP) and vein, and dorsolateral
intercostal artery perforator (DLICAP) and vein were 1.03, 1.67, 1.38, 1.84, 1.28,
1.84, 1.01, 1.60, 1.11, and 1.70 mm. In the clinical study, the propensity score-matched
analysis involving eight pairs showed a significantly higher occurrence of total complications
in the pedicled-flap group than the free-flap group (62.5 vs. 0%, p = 0.03).
Conclusion The cadaveric study showed that the perforators from the SCA, DSA, and posterior
intercostal artery are constantly present. The clinical study demonstrated the feasibility
and reliability of a free-flap transfer.
Keywords sarcoma - trunk - reconstruction - PAP flap
