Lumbar BCC removal and reconstruction with a perforator plus flap

The lower back still remains a challenging area for a reconstructive surgeon, especially when it comes to a big defect. A 78-year-old man presented with a neglected basal cell carcinoma (BCC). He underwent excision of the lesion and reconstruction of the 18 × 10-cm defect with a lumbar perforator plus flap. His operation and final outcome are presented, and the possible options for reconstruction are discussed. The advantages of the rotational design, the axial blood supply, and the skin island preservation are reported, giving the lumbar perforator plus flap a definite role in a difficult area such as the lower back. Level of Evidence: Level V, therapeutic study.