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Dorchester Center, MA 02124
Upper Back Reconstruction
Clinical Presentation
A 63-year-old White male underwent a wide local excision of his upper back soft tissue sarcoma by the surgical oncology service, which left a 12 × 12 cm large soft tissue defect down to the deep muscle. The plastic surgery service was asked to help to close this wound after the wide local excision had been made for the primary sarcoma resection leaving an adequate margin. Thus, the definitive soft tissue reconstruction would be performed in the same setting immediately after oncological resection of the primary tumor ( Fig. 28.1 ).
Operative Plan and Special Considerations
Because the location of this soft tissue defect was primarily in the upper back and the trapezius muscle in the adjacent area remained intact after the wide local excision, bilateral trapezius myocutaneous advancement flaps could be used to close this soft tissue defect. The flap receives blood supply from the transverse cervical artery and can be approximated in the midline of the upper back. Its attachment to the thoracic vertebrae could be released. Such a reconstruction could eventually provide a durable soft tissue coverage, best possible cosmetic outcome, and almost no donor site healing issues.
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