{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:36:15Z","timestamp":1789450575462,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T00:00:00Z","timestamp":1591228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Reconstruction of complex back defects is challenging for reconstructive surgeons, as it should preserve function, provide adequate coverage, and minimize morbidity. We present a case of multiple\u2010step reconstruction after resection of a large squamous cell carcinoma recurrence in a 68\u2010year\u2010old man, with local perforator flaps and a reverse\u2010flow latissimus dorsi myocutaneous flap. After radical excision, four propeller perforator flaps were harvested to cover a 30\u2009\u00d7\u200925\u2009cm defect, based on the dorsal branch of the fifth posterior intercostal arteries (right 20\u2009\u00d7\u20099\u2009cm, left 17\u2009\u00d7\u20099\u2009cm) and on the superior gluteal arteries (right 20\u2009\u00d7\u200911\u2009cm, left 21\u2009\u00d7\u200912\u2009cm) bilaterally. In the second step, bilateral propeller perforator flaps based on the fourth lumbar arteries (right 18\u2009\u00d7\u200913\u2009cm, left 23\u2009\u00d7\u200911\u2009cm) were transposed to cover the residual loss of tissues. After 5\u2009months, a recurrence occurred on the left midback. A wide en bloc excision of the last three ribs and pulmonary pleura was performed, and the synthetic mesh used for thoracic wall reconstruction was covered with an ipsilateral 20\u2009\u00d7\u200910\u2009cm reverse\u2010flow latissimus dorsi myocutaneous flap based on the serratus anterior branch. All the flaps healed uneventfully and there were no donor\u2010site complications. Two years postoperatively, the patient had a cosmetically acceptable result without any functional impairment. The reverse\u2010flow latissimus dorsi myocutaneous flap can represent a salvage procedure in back complex defects reconstruction, especially when other local flaps have already been harvested in previous reconstructive procedures.<\/jats:p>","DOI":"10.1002\/micr.30615","type":"journal-article","created":{"date-parts":[[2020,6,4]],"date-time":"2020-06-04T18:45:15Z","timestamp":1591296315000},"page":"604-607","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Reverse\u2010flow latissimus dorsi myocutaneous flap in a multi\u2010step approach for complex back defect reconstruction: A case report"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1858-3964","authenticated-orcid":false,"given":"Giulio","family":"Menichini","sequence":"first","affiliation":[{"name":"Plastic and Reconstructive Microsurgery Careggi University Hospital  Florence 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