Introduction: Soft tissue reconstruction of lumbosacral wounds after tumor extirpation is a difficult problem. These defects are large, irradiated and have failed conservative management. Local flap options may not be available, requiring free tissue transfer.

Methods: Reviewed of patient database over a 12-year period. 9 patients were identified with complex mid-back wounds treated with free flap coverage.

Results: 7 different types of neoplasms were resected and 6 (67%) had been irradiated. 7 (78%) patients required saphenous vein arteriovenous fistulas and 2 (22%) received vascularization from local vessels. 4 of the 7 (57%) vein loops were staged 48 hours prior to flap transfer. There were 6 latissimus dorsi muscle flaps, 1 latissimus dorsi musculocutaneous flap, 1 rectus abdominus muscle flap and 1 rectus abdominus musculocutaneous flap used for reconstruction. 6 of the 9(67%) remained viable and healed without incident. 3 (33%) failed and required revision. 2 of the 3 failed flaps were in irradiated tissue beds and 1 had been transferred with a nonstaged vein loop.

Conclusion: Free tissue transfer for complex back wounds is a reasonable reconstructive option when locoregional techniques have been exhausted. We perform a staged saphenous vein arteriovenous fistula 48 hours prior to tissue transfer.