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Back Reconstruction: Multimedia

Author: Arvind N Padubidri, MD, FRCSEd, Chairman, Forum Health, Assistant Professor of Plastic Surgery, Department of Plastic Surgery, Northside Medical Center and Trumbull Memorial Hospital
Coauthor(s): Armand R Lucas, MD, Attending Plastic Surgeon, Department of Plastic Surgery, Cleveland Clinic Foundation
Contributor Information and Disclosures

Updated: Aug 22, 2008

Multimedia

Elderly man with a recurrent squamous cell carcin...Media file 1: Elderly man with a recurrent squamous cell carcinoma of the occipital scalp extending to the neck.
Elderly man with a recurrent squamous cell carcin...

Elderly man with a recurrent squamous cell carcinoma of the occipital scalp extending to the neck.

Close-up view of an elderly man with a recurrent ...Media file 2: Close-up view of an elderly man with a recurrent squamous cell carcinoma of the occipital scalp extending to the neck.
Close-up view of an elderly man with a recurrent ...

Close-up view of an elderly man with a recurrent squamous cell carcinoma of the occipital scalp extending to the neck.

Defect down to the brain, following wide excision...Media file 3: Defect down to the brain, following wide excision of the tumor.
Defect down to the brain, following wide excision...

Defect down to the brain, following wide excision of the tumor.

Skin markings showing the planned trapezius islan...Media file 4: Skin markings showing the planned trapezius island myocutaneous flap to repair defect down to the brain following wide excision of the tumor.
Skin markings showing the planned trapezius islan...

Skin markings showing the planned trapezius island myocutaneous flap to repair defect down to the brain following wide excision of the tumor.

Well-settled stable flap covering the defect on ...Media file 5: Well-settled stable flap covering the defect on the lateral cervical spine and the adjoining scalp.
Well-settled stable flap covering the defect on ...

Well-settled stable flap covering the defect on the lateral cervical spine and the adjoining scalp.

Middle-aged man with squamous cell carcinoma over...Media file 6: Middle-aged man with squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.
Middle-aged man with squamous cell carcinoma over...

Middle-aged man with squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.

Defect following wide excision of squamous cell c...Media file 7: Defect following wide excision of squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.
Defect following wide excision of squamous cell c...

Defect following wide excision of squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.

Reconstruction with ipsilateral latissimus dorsi ...Media file 8: Reconstruction with ipsilateral latissimus dorsi muscle flap and skin graft of defect following wide excision of squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.
Reconstruction with ipsilateral latissimus dorsi ...

Reconstruction with ipsilateral latissimus dorsi muscle flap and skin graft of defect following wide excision of squamous cell carcinoma over lateral thoracic and left scapular area, developing from chronic hidradenitis.

Defect secondary to spina bifida at the thoracic ...Media file 9: Defect secondary to spina bifida at the thoracic level in a 5-year-old child.
Defect secondary to spina bifida at the thoracic ...

Defect secondary to spina bifida at the thoracic level in a 5-year-old child.

Close-up view of defect secondary to spina bifida...Media file 10: Close-up view of defect secondary to spina bifida at the thoracic level in a 5-year-old child.
Close-up view of defect secondary to spina bifida...

Close-up view of defect secondary to spina bifida at the thoracic level in a 5-year-old child.

Repair of defect secondary to spina bifida at the...Media file 11: Repair of defect secondary to spina bifida at the thoracic level in a 5-year-old child with bilateral advancement of latissimus dorsi muscles and skin closure.
Repair of defect secondary to spina bifida at the...

Repair of defect secondary to spina bifida at the thoracic level in a 5-year-old child with bilateral advancement of latissimus dorsi muscles and skin closure.

Complete healing of defect secondary to spina bif...Media file 12: Complete healing of defect secondary to spina bifida at the thoracic level in a 5-year-old child, repaired with bilateral advancement of latissimus dorsi muscles and skin closure, with a stable scar at 8 weeks postsurgery.
Complete healing of defect secondary to spina bif...

Complete healing of defect secondary to spina bifida at the thoracic level in a 5-year-old child, repaired with bilateral advancement of latissimus dorsi muscles and skin closure, with a stable scar at 8 weeks postsurgery.

Exposed hardware at the thoracic spine in a middl...Media file 13: Exposed hardware at the thoracic spine in a middle-aged man.
Exposed hardware at the thoracic spine in a middl...

Exposed hardware at the thoracic spine in a middle-aged man.

Repair of exposed hardware at the thoracic spine ...Media file 14: Repair of exposed hardware at the thoracic spine in a middle-aged man with bilateral paraspinal muscle flaps.
Repair of exposed hardware at the thoracic spine ...

Repair of exposed hardware at the thoracic spine in a middle-aged man with bilateral paraspinal muscle flaps.

Young quadriplegic man who has undergone several ...Media file 15: Young quadriplegic man who has undergone several spinal surgeries with an unstable scar over the thoracolumbar area.
Young quadriplegic man who has undergone several ...

Young quadriplegic man who has undergone several spinal surgeries with an unstable scar over the thoracolumbar area.

Bilateral bipedicle advancement of latissimus myo...Media file 16: Bilateral bipedicle advancement of latissimus myocutaneous flaps is elevated.
Bilateral bipedicle advancement of latissimus myo...

Bilateral bipedicle advancement of latissimus myocutaneous flaps is elevated.

Lateral relaxing incisions.Media file 17: Lateral relaxing incisions.
Lateral relaxing incisions.

Lateral relaxing incisions.

Flaps are approximated in the mid line to result ...Media file 18: Flaps are approximated in the mid line to result in a tension-free closure.
Flaps are approximated in the mid line to result ...

Flaps are approximated in the mid line to result in a tension-free closure.

Two random transposition flaps raised to close a ...Media file 19: Two random transposition flaps raised to close a defect in the thoracolumbar area.
Two random transposition flaps raised to close a ...

Two random transposition flaps raised to close a defect in the thoracolumbar area.

Result at 2 months, showing stable scar after 2 r...Media file 20: Result at 2 months, showing stable scar after 2 random transposition flaps were raised to close a defect in the thoracolumbar area.
Result at 2 months, showing stable scar after 2 r...

Result at 2 months, showing stable scar after 2 random transposition flaps were raised to close a defect in the thoracolumbar area.

Lumbar defect following excision of melanoma.Media file 21: Lumbar defect following excision of melanoma.
Lumbar defect following excision of melanoma.

Lumbar defect following excision of melanoma.

Closure of lumbar defect following excision of me...Media file 22: Closure of lumbar defect following excision of melanoma with 2 rhomboid flaps.
Closure of lumbar defect following excision of me...

Closure of lumbar defect following excision of melanoma with 2 rhomboid flaps.

Grade IV sacral pressure ulcer in an elderly pati...Media file 23: Grade IV sacral pressure ulcer in an elderly patient.
Grade IV sacral pressure ulcer in an elderly pati...

Grade IV sacral pressure ulcer in an elderly patient.

Reconstruction of grade IV sacral pressure ulcer ...Media file 24: Reconstruction of grade IV sacral pressure ulcer in an elderly patient with a large, inferiorly based buttock rotation skin flap.
Reconstruction of grade IV sacral pressure ulcer ...

Reconstruction of grade IV sacral pressure ulcer in an elderly patient with a large, inferiorly based buttock rotation skin flap.

Sacral osteoradionecrosis in an elderly woman.Media file 25: Sacral osteoradionecrosis in an elderly woman.
Sacral osteoradionecrosis in an elderly woman.

Sacral osteoradionecrosis in an elderly woman.

Posterior gluteal thigh flap undergoing elevation...Media file 26: Posterior gluteal thigh flap undergoing elevation to repair sacral osteoradionecrosis in an elderly woman.
Posterior gluteal thigh flap undergoing elevation...

Posterior gluteal thigh flap undergoing elevation to repair sacral osteoradionecrosis in an elderly woman.

Flap is inset and the secondary defect closed dir...Media file 27: Flap is inset and the secondary defect closed directly to repair sacral osteoradionecrosis in an elderly woman.
Flap is inset and the secondary defect closed dir...

Flap is inset and the secondary defect closed directly to repair sacral osteoradionecrosis in an elderly woman.

More on Back Reconstruction

Overview: Back Reconstruction
Workup: Back Reconstruction
Treatment: Back Reconstruction
Multimedia: Back Reconstruction
References

References

  1. Vyas SC, Binns JH, Wilson AN. Thoracolumbar-sacral flaps in the treatment of sacral pressure sores. Plast Reconstr Surg. Feb 1980;65(2):159-63. [Medline].

  2. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. Dec 1995;96(7):1608-14. [Medline].

  3. Blaiklock CR, Demetriou EL, Rayner CR. The use of a latissimus dorsi myocutaneous flap in the repair of spinal defects in spina bifida. Br J Plast Surg. Jul 1981;34(3):358-61. [Medline].

  4. Bostwick J 3rd, Scheflan M, Nahai F, et al. The "reverse" latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations. Plast Reconstr Surg. Apr 1980;65(4):395-9. [Medline].

  5. Nahai F, Hagerty R. One-stage microvascular transfer of a latissimus flap to the sacrum using vein grafts. Plast Reconstr Surg. Feb 1986;77(2):312-5. [Medline].

  6. Stevenson TR, Rohrich RJ, Pollock RA, et al. More experience with the "reverse" latissimus dorsi musculocutaneous flap: precise location of blood supply. Plast Reconstr Surg. Aug 1984;74(2):237-43. [Medline].

  7. Baran CN, Celebioglu S, Civelek B, et al. Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores. Plast Reconstr Surg. Jun 1999;103(7):2071-6; quiz 2077. [Medline].

  8. Ramirez OM, Orlando JC, Hurwitz DJ. The sliding gluteus maximus myocutaneous flap: its relevance in ambulatory patients. Plast Reconstr Surg. Jul 1984;74(1):68-75. [Medline].

  9. Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg. Apr 1988;81(4):561-6. [Medline].

  10. Ao M, Mae O, Namba Y, et al. Perforator-based flap for coverage of lumbosacral defects. Plast Reconstr Surg. Apr 1998;101(4):987-91. [Medline].

  11. Daniel RK, Kerrigan CL, Gard DA. The great potential of the intercostal flap for torso reconstruction. Plast Reconstr Surg. May 1978;61(5):653-65. [Medline].

  12. Evans GR, Reece GP. Lower back reconstruction: an approach to wound closure in the cancer patient. Plast Reconstr Surg. Sep 1995;96(3):635-42. [Medline].

  13. Fiala TG, Buchman SR, Muraszko KM. Use of lumbar periosteal turnover flaps in myelomeningocele closure. Neurosurgery. Sep 1996;39(3):522-5; discussion 525-6. [Medline].

  14. Hill C, Riaz M. A new twist to the myocutaneous turnover flap for closure of a spinal defect. Plast Reconstr Surg. Sep 1998;102(4):1167-70. [Medline].

  15. Hill HL, Brown RG, Jurkiewicz MJ. The transverse lumbosacral back flap. Plast Reconstr Surg. Aug 1978;62(2):177-84. [Medline].

  16. Hung SJ, Chen HC, Wei FC. Free flaps for reconstruction of the lower back and sacral area. Microsurgery. 2000;20(2):72-6. [Medline].

  17. Iacobucci JJ, Marks MW, Argenta LC. Anatomic studies and clinical experience with fasciocutaneous flap closure of large myelomeningoceles. Plast Reconstr Surg. Jun 1996;97(7):1400-8; discussion 1409-10. [Medline].

  18. Kato H, Hasegawa M, Takada T, et al. The lumbar artery perforator based island flap: anatomical study and case reports. Br J Plast Surg. Oct 1999;52(7):541-6. [Medline].

  19. Moore TS, Dreyer TM, Bevin AG. Closure of large spina bifida cystica defects with bilateral bipedicled musculocutaneous flaps. Plast Reconstr Surg. Feb 1984;73(2):288-92. [Medline].

  20. Mustarde JC. Reconstruction of the spinal canal in severe spina bifida. Plast Reconstr Surg. Aug 1968;42(2):109-14. [Medline].

  21. Ramirez OM, Ramasastry SS, Granick MS, et al. A new surgical approach to closure of large lumbosacral meningomyelocele defects. Plast Reconstr Surg. Dec 1987;80(6):799-809. [Medline].

  22. Roche NA, Van Landuyt K, Blondeel PN, et al. The use of pedicled perforator flaps for reconstruction of lumbosacral defects. Ann Plast Surg. Jul 2000;45(1):7-14. [Medline].

  23. Thomas CV. Closure of large spina bifida defects: a simple technique based on anatomical details. Ann Plast Surg. Dec 1993;31(6):522-7. [Medline].

  24. Verpaele AM, Blondeel PN, Van Landuyt K, et al. The superior gluteal artery perforator flap: an additional tool in the treatment of sacral pressure sores. Br J Plast Surg. Jul 1999;52(5):385-91. [Medline].

  25. Wendt JR, Gardner VO, White JI. Treatment of complex postoperative lumbosacral wounds in nonparalyzed patients. Plast Reconstr Surg. Apr 1998;101(5):1248-53; discussion 1254. [Medline].

  26. Wilhelmi BJ, Snyder N, Colquhoun T, et al. Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study. Plast Reconstr Surg. Nov 2000;106(6):1305-11. [Medline].

Further Reading

Keywords

back reconstruction, complex posterior trunk defects, posterior trunk defects, trunk repair, muscle-based flaps, perforator-based flaps, free tissue transfer, spina bifida, skin graft, skin flaps, Limberg flaps, rhomboid flap, skin rotation flap, thoracolumbar sacral skin flap, transverse lumbosacral back flap, intercostal neurovascular island skin flap, scapular and parascapular flap, tissue expansion, muscle flap, myocutaneous flap, trapezius flap, latissimus dorsi flap, bilateral advancement flap, bilateral bipedicle myocutaneous flap, latissimus dorsi triangular island advancement flap, serratus anterior, gluteus maximus flap, segmental muscle flap, paraspinous muscle flap, fasciocutaneous flap, paralumbar flap, gluteal thigh flap, perforator flap, periosteal flap, osteocutaneous flap, osteomuscular flap, osseomusculocutaneous flap, omental flap, free flap, innervated flap, filleted leg tissue

Contributor Information and Disclosures

Author

Arvind N Padubidri, MD, FRCSEd, Chairman, Forum Health, Assistant Professor of Plastic Surgery, Department of Plastic Surgery, Northside Medical Center and Trumbull Memorial Hospital
Arvind N Padubidri, MD, FRCSEd is a member of the following medical societies: American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Armand R Lucas, MD, Attending Plastic Surgeon, Department of Plastic Surgery, Cleveland Clinic Foundation
Armand R Lucas, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Orgill, MD, PhD, Associate Professor, Harvard Medical School; Director, Burn Center, Brigham and Women's Hospital
Dennis P Orgill, MD, PhD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council
Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Marine Polymers  Grant/research funds Principle Investigator; Naval Blood Research Lab Grant/research funds Principle Investigator

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jaime R Garza, MD, DDS, FACS, Consulting Staff, Private Practice
Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

 
 
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