Phase 2 Trial of Difelikefalin in Notalgia Paresthetica.

BACKGROUND: Notalgia paresthetica is a neuropathic disorder characterized by pruritus in a circumscribed region of the upper back. Difelikefalin, a selective kappa opioid receptor agonist, has shown efficacy in other chronic pruritic conditions and is being investigated for the treatment of notalgia paresthetica. METHODS: In this phase 2, double-blind, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, patients with moderate-to-severe pruritus caused by notalgia paresthetica to receive 2 mg of oral difelikefalin or placebo twice daily for 8 weeks. The primary outcome was the change from baseline at week 8 in the weekly mean score on the daily Worst Itch Numeric Rating Scale (WI-NRS; scores range from 0 [no itch] to 10 [worst itch imaginable]). The secondary clinical outcomes were itch-related quality-of-life and itch-related sleep measures. RESULTS: A total of 126 patients were enrolled; 62 patients were assigned to receive difelikefalin, and 63 were assigned to receive placebo. One patient who had been assigned to receive difelikefalin withdrew consent before the first dose and is not included in the main analyses. The mean baseline WI-NRS score was 7.6 (indicating severe itch) in each group. The change from baseline in the weekly mean WI-NRS score at week 8 was -4.0 points in the difelikefalin group and -2.4 points in the placebo group (difference in change, -1.6 points; 95% confidence interval, -2.6 to -0.6; P = 0.001). The results for the secondary outcomes generally did not support those of the primary analysis. Headache, dizziness, constipation, and increased urine output occurred more frequently in the difelikefalin group than in the placebo group. CONCLUSIONS: Among patients with notalgia paresthetica, oral treatment with difelikefalin resulted in modestly greater reductions in itch intensity scores than placebo over a period of 8 weeks but was associated with adverse events. Larger and longer trials are needed to assess the efficacy and safety of difelikefalin treatment in this disorder. (Funded by Cara Therapeutics; KOMFORT ClinicalTrials.gov number, NCT04706975.).

Temperature probe placement in very preterm infants during delivery room stabilization: an open-label randomized trial.

BACKGROUND: Variation in practice exists for temperature probe positioning during stabilization of very preterm infants (<32 weeks gestation). We explored the influence of temperature probe sites on thermoregulation. METHODS: An open-label, stratified, balanced, parallel, randomized trial was conducted. Inborn infants were randomly assigned temperature probe to the axilla or to the upper back. The primary outcome was normothermia (local range: 36.8-37.3 °C and World Health Organization (WHO) range: 36.5-37.5 °C) at admission to the neonatal intensive care unit. RESULTS: Between 1 November 2018 and 4 July 2022, 178 infants were randomly assigned to one of the two sites (n = 89 each), 175 included in the final analysis. Normothermia (local range) was achieved for 39/87 infants (44.8%) assigned to the upper back compared to 28/88 infants (31.8%) assigned to the axilla [risk difference:13%; 95% CI -1.3-27.3]. Normothermia (WHO range) was achieved for 78/87 infants (89.7%) assigned to the upper back compared to 70/88 infants (79.6%) assigned to the axilla [risk difference:10.1%; 95% CI -0.5-20.7]. No infant recorded temperatures >38 °C or developed skin injury. CONCLUSIONS: In very preterm infants, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. CLINICAL TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000293965). IMPACT: Substantial variation in practice exists for the site of securing a temperature probe during delivery room stabilization of very preterm infants and the influence of temperature probe site on thermoregulation remains unknown. In this study, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. Clinicians could adopt upper back site for maintaining normothermia. This study may contribute data to future international participant data prospective meta analysis of randomized controlled trials worldwide on temperature probe positioning in very preterm infants, increasing translation of research findings to optimize thermoregulation and clinical outcomes.

Conjoined thoracodorsal perforator-supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps.

The reported complications' rate of perforator propeller flaps is variably high, but the etiology of distal flap necrosis, potentially linked to vascular insufficiency, is yet to be clarified. Vascular augmentation procedures have been previously described involving an extra anastomosis of a superficial vein, while a perforator-to-perforator supercharging approach has been only sporadically documented in literature. We present a case of perforator-to-perforator vascular supercharging of an extended dorsal intercostal artery perforator (DICAP) propeller flap to provide a salvage option for pedicled flap complicated by venous congestion. A 71-year-old male patient underwent Dermatofibrosarcoma Protuberans resection in the upper back, leading to a 17 × 17 cm defect with bone exposure. A 30 × 9 cm DICAP propeller flap was planned, with the distal third of the flap designed over the adjacent Thoracodorsal artery perforasome, in a conjoined fashion. Considering the small DICAP pedicle caliber and the flap lateral extension, a thoracodorsal artery perforator vein was dissected and included in the distal flap. Once the flap was raised on its main pedicle, the skin paddle turned blue, showing signs of venous insufficiency. Indocyanine green angiography (ICG) showed a viable proximal half of the flap. Hence, after rotating the skin paddle to reach the upper margin of the defect, an additional anastomosis between the perforating thoracodorsal vein and the perforating vein of the dorsal scapular pedicle was performed according to the perforator-to-perforator approach. Doing so, both clinical and ICG examinations showed a well perfused flap, with normal capillary refill. The postoperative course was uneventful, and the patient obtained a good oncological and reconstructive result 4 months postoperatively. The second Vasconez law ("all of the flap will survive except the part that you need") is often encountered in propeller flaps surgery. Our case shows that it is possible to prevent or overcome this problem by planning appropriate vascular augmentation procedures according to the perforator-to-perforator approach, being guided by advanced vascular imaging tools like ICG.

A Rare Case of a Basomelanocytic Tumor.

ABSTRACT: Basal cell carcinomas and melanoma are common cutaneous malignancies. However, the development of a basomelanocytic tumor that simultaneously includes elements of melanoma and basal cell carcinoma is extremely rare. We present the case of an 84-year-old man who presented with a nonpigmented, nonulcerated pink nodule of his left upper back and discuss the current management recommendations for basomelanocytic tumors.

A Method for Quantifying Back Flexion/Extension from Three Inertial Measurement Units Mounted on a Horse's Withers, Thoracolumbar Region, and Pelvis.

Back mobility is a criterion of well-being in a horse. Veterinarians visually assess the mobility of a horse's back during a locomotor examination. Quantifying it with on-board technology could be a major breakthrough to help them. The aim of this study was to evaluate the accuracy of a method of quantifying the back mobility of horses from inertial measurement units (IMUs) compared to motion capture (MOCAP) as a gold standard. Reflective markers and IMUs were positioned on the withers, eighteenth thoracic vertebra, and pelvis of four sound horses. The horses performed a walk and trot in straight lines and performed a gallop in circles on a soft surface. The developed method, based on the three IMUs, consists of calculating the flexion/extension angle of the thoracolumbar region. The IMU method showed a mean bias of 0.8° (±1.5°) (mean (±SD)) and 0.8° (±1.4°), respectively, for the flexion and extension movements, all gaits combined, compared to the MOCAP method. The results of this study suggest that the developed method has a similar accuracy to that of MOCAP, opening up possibilities for easy measurements under field conditions. Future studies will need to examine the correlations between these biomechanical measures and clinicians' visual assessment of back mobility defects.

The Effect of Key Anthropometric and Biomechanics Variables Affecting the Lower Back Forces of Healthcare Workers.

Wearable devices are becoming ubiquitous and can be used to better estimate postures and movements to reduce the risk of injuries. Thirty-three participants were recruited in this study to perform two daily repetitive patient transfer tasks while the full body movements were acquired using a set of magneto-inertial wearable devices. The use of wearable devices allowed for the estimation of the forces provoked on the lower back during the entire task performance. In postures where the forces exceeded the warning threshold found in the literature, healthcare workers were considered to have a greater risk of injury. Additionally, the maximum force exerted by each hand to avoid injury to the spinal column was also estimated. Knowing the key anthropometric variables associated with musculoskeletal disorders (MSDs) will enable engineers and researchers to design better assistive devices and injury prevention programs in diverse workplaces.

Estimation of Ground Contact Time with Inertial Sensors from the Upper Arm and the Upper Back.

Ground contact time (GCT) is one of the most relevant factors when assessing running performance in sports practice. In recent years, inertial measurement units (IMUs) have been widely used to automatically evaluate GCT, since they can be used in field conditions and are friendly and easy to wear devices. In this paper we describe the results of a systematic search, using the Web of Science, to assess what reliable options are available to GCT estimation using inertial sensors. Our analysis reveals that estimation of GCT from the upper body (upper back and upper arm) has rarely been addressed. Proper estimation of GCT from these locations could permit an extension of the analysis of running performance to the public, where users, especially vocational runners, usually wear pockets that are ideal to hold sensing devices fitted with inertial sensors (or even using their own cell phones for that purpose). Therefore, in the second part of the paper, an experimental study is described. Six subjects, both amateur and semi-elite runners, were recruited for the experiments, and ran on a treadmill at different paces to estimate GCT from inertial sensors placed at the foot (for validation purposes), the upper arm, and upper back. Initial and final foot contact events were identified in these signals to estimate the GCT per step, and compared to times estimated from an optical MOCAP (Optitrack), used as the ground truth. We found an average error in GCT estimation of 0.01 s in absolute value using the foot and the upper back IMU, and of 0.05 s using the upper arm IMU. Limits of agreement (LoA, 1.96 times the standard deviation) were [-0.01 s, 0.04 s], [-0.04 s, 0.02 s], and [0.0 s, 0.1 s] using the sensors on the foot, the upper back, and the upper arm, respectively.

Validation of an Algorithm for Measurement of Sedentary Behaviour in Community-Dwelling Older Adults.

Accurate measurement of sedentary behaviour in older adults is informative and relevant. Yet, activities such as sitting are not accurately distinguished from non-sedentary activities (e.g., upright activities), especially in real-world conditions. This study examines the accuracy of a novel algorithm to identify sitting, lying, and upright activities in community-dwelling older people in real-world conditions. Eighteen older adults wore a single triaxial accelerometer with an onboard triaxial gyroscope on their lower back and performed a range of scripted and non-scripted activities in their homes/retirement villages whilst being videoed. A novel algorithm was developed to identify sitting, lying, and upright activities. The algorithm's sensitivity, specificity, positive predictive value, and negative predictive value for identifying scripted sitting activities ranged from 76.9% to 94.8%. For scripted lying activities: 70.4% to 95.7%. For scripted upright activities: 75.9% to 93.1%. For non-scripted sitting activities: 92.3% to 99.5%. No non-scripted lying activities were captured. For non-scripted upright activities: 94.3% to 99.5%. The algorithm could, at worst, overestimate or underestimate sedentary behaviour bouts by ±40 s, which is within a 5% error for sedentary behaviour bouts. These results indicate good to excellent agreement for the novel algorithm, providing a valid measure of sedentary behaviour in community-dwelling older adults.

Using Raw Accelerometer Data to Predict High-Impact Mechanical Loading.

The purpose of this study was to develop peak ground reaction force (pGRF) and peak loading rate (pLR) prediction equations for high-impact activities in adult subjects with a broad range of body masses, from normal weight to severe obesity. A total of 78 participants (27 males; 82.4 ± 20.6 kg) completed a series of trials involving jumps of different types and heights on force plates while wearing accelerometers at the ankle, lower back, and hip. Regression equations were developed to predict pGRF and pLR from accelerometry data. Leave-one-out cross-validation was used to calculate prediction accuracy and Bland-Altman plots. Body mass was a predictor in all models, along with peak acceleration in the pGRF models and peak acceleration rate in the pLR models. The equations to predict pGRF had a coefficient of determination (R2) of at least 0.83, and a mean absolute percentage error (MAPE) below 14.5%, while the R2 for the pLR prediction equations was at least 0.87 and the highest MAPE was 24.7%. Jumping pGRF can be accurately predicted through accelerometry data, enabling the continuous assessment of mechanical loading in clinical settings. The pLR prediction equations yielded a lower accuracy when compared to the pGRF equations.

Effects of Postural Shifting Frequency on Perceived Musculoskeletal Discomfort During 1-Hour Sitting in Office Workers.

OBJECTIVE: The purpose of this study was to evaluate the effects of postural shifting frequency on perceived musculoskeletal discomfort during 1 hour of sitting in healthy office workers. METHODS: An experimental study comparing 3 different postural shifting frequencies was conducted on 60 healthy office workers who were asked to sit for an hour. The effects of 3 postural shifts (ie, 10, 20, and 30 times/h) on discomfort, measured by Borg's CR-10 scale, were compared. A seat pressure mat was used to confirm an individual's postural shift. RESULTS: Postural shifting frequency of 10 to 30 times/h had significant effects on perceived discomfort in the neck, shoulder, and upper and lower back during 1-hour sitting. At the neck and shoulder, a postural shifting frequency of 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h during 1-hour sitting. At the upper and lower back, a postural shifting frequency of 20 to 30 times/h significantly reduced perceived discomfort compared to a postural shifting frequency of 10 times/h. CONCLUSION: Postural shifts of 30 times/h provided buffering effects on perceived musculoskeletal discomfort at the neck, shoulder, and upper and lower back.

Annular plaques on the back.

Annular lichen planus is a rare clinical variant of the lichen planus presenting with round-oval, red to brown macules and plaques with no central atrophy and slightly raised, nonscaly borders. Histopathological features are indistinguishable from typical lichen planus. Given that the accurate diagnosis relies on both the clinical presentation and typical histological features, it is important to be aware of the clinical spectrum of lichen planus. Click https://wileyhealthlearning.com/#/online-courses/6be3b20c-e9c3-40e9-8f36-bfcda6718a73 for the corresponding questions to this CME article.

Necrotizing Infundibular Crystalline Folliculitis-A Case Report of a Rare Entity and Review of the Literature.

ABSTRACT: Necrotizing infundibular crystalline folliculitis (NICF) is a rare distinct entity that was introduced in 1999. It typically presents with numerous eruptive waxy papules on the forehead and/or the upper back in adults in their fifth to seventh decade of life. The pathogenesis is unknown to date, but yeast and bacterial infection of the follicular ostia seems to contribute to the development. More recently, NICF has occasionally been observed as a side effect of targeted antitumoral therapy. Histopathologically, NICF is characterized by dilated follicular ostia filled with pale filamentous and birefringent material enclosed by parakeratotic columns of the epidermis and accompanied by a mild superficial inflammatory infiltrate of the dermis. This case report is about a 58-year-old male patient presenting with multiple eruptive keratotic papules on his forehead. Histopathology revealed all classic features of NICF. The case represents a classic example of NICF and is compared with previously published cases that are comprehensively summarized in this article.

The Principles and Practice of Primary Endonasal Rhinoplasty.

ABSTRACT: The purpose of this article is to provide a guide for plastic surgeons, regardless of experience level, seeking to improve his/her endonasal rhinoplasty skills and comfort level. We have presented the advantages of our technique and its unifying principles and demonstrated how endonasal rhinoplasty can be used to achieve safe, anatomical, and predictable outcomes. Endonasal rhinoplasty is a separate thought process from open rhinoplasty and should not be viewed as a competing but rather parallel technique that is broadly applicable to many nasal deformities.We have described the basic goals of all rhinoplasties and highlighted 2 false assumptions that are responsible for most adverse rhinoplasty outcomes and 4 anatomical deficits that surgeons must recognize preoperatively to maximize function, proportion, and contour. Finally, the majority of primary rhinoplasties can be performed with 1 of 2 operative strategies that depend on the relationship of the dorsum to the lower nose. Because surgeons often presume that they will not be able to "see well enough" in endonasal rhinoplasty or worry they have not been adequately trained in the technique, we have provided a step-by-step guide to help overcome such fears and help these surgeons to achieve results that will exceed their patients' goals.

Technical Variations in the Management of the Medial Crural Reduction According to the Settlement of the Angulation Deformities Over Hypertrophic Lower Lateral Cartilages.

BACKGROUND: Medial crural (MC) overlay is reliable method used in tip deprojection. Most cases with lower lateral cartilage (LLC) hypertrophy present by variations of MC and dome shapes needing specific technical maneuvers. METHODS: Thirteen hundred fourteen primary rhinoplasties were performed between 2018 and 2021. Patients with LLC hypertrophy who underwent MC deprojection were analyzed. Three variations in LLC hypertrophy were recognized. In type I, tip-defining points (TDP) were localized at the median plane with no angulation deformities at the LLC, which was managed by horizontal cuts of the lobular segments 4 to 6 mm below the domes. The cut fragments overlapped for 2 to 5 mm. In type II, TDP was lateralized due to widened divergence angles at the columellalobular junctions, which were managed by horizontal cuts over columellalobular junctions. The cut fragments overlapped 4 to 6 mm. In type III, TDP was localized at the median plane, there were dense angulations at the medial genu, which was managed with symmetrical removal of 4 to 5 mm cartilage from lobular segments. The domes were sutured over the medial segments. RESULTS: Nineteen patients with LLC hypertrophy were included in the study among 314 patients. Twelve patients were female and 7 patients were male. The mean age was 32 years (25-42). Type I, II, and III LLC hypertrophies were detected in 10, 3, and 6 patients, respectively. A harmonious relationship between dorsum and tip and satisfactory tip stability was reached in all patients. CONCLUSIONS: By classification of variations of MC and domal shapes, LLC hypertrophies may be managed with proper technical maneuvers specific to each type.

Application of the Two-Dimensional Entropy Measures in the Infrared Thermography-Based Detection of Rider: Horse Bodyweight Ratio in Horseback Riding.

As obesity is a serious problem in the human population, overloading of the horse's thoracolumbar region often affects sport and school horses. The advances in using infrared thermography (IRT) to assess the horse's back overload will shortly integrate the IRT-based rider-horse fit into everyday equine practice. This study aimed to evaluate the applicability of entropy measures to select the most informative measures and color components, and the accuracy of rider:horse bodyweight ratio detection. Twelve horses were ridden by each of the six riders assigned to the light, moderate, and heavy groups. Thermal images were taken pre- and post-exercise. For each thermal image, two-dimensional sample (SampEn), fuzzy (FuzzEn), permutation (PermEn), dispersion (DispEn), and distribution (DistEn) entropies were measured in the withers and the thoracic spine areas. Among 40 returned measures, 30 entropy measures were exercise-dependent, whereas 8 entropy measures were bodyweight ratio-dependent. Moreover, three entropy measures demonstrated similarities to entropy-related gray level co-occurrence matrix (GLCM) texture features, confirming the higher irregularity and complexity of thermal image texture when horses worked under heavy riders. An application of DispEn to red color components enables identification of the light and heavy rider groups with higher accuracy than the previously used entropy-related GLCM texture features.

A Pilot Study on the Inter-Operator Reproducibility of a Wireless Sensors-Based System for Quantifying Gait Asymmetries in Horses.

Repeatability and reproducibility of any measuring system must be evaluated to assess possible limitations for its use. The objective of this study was to establish the repeatability and the inter-operator reproducibility of a sensors-based system (EQUISYM®) for quantifying gait asymmetries in horses.. Seven wireless IMUs were placed on the head, the withers, the pelvis, and the 4 cannon bones on three horses, by four different operators, four times on each horse, which led to a total of 48 repetitions randomly assigned. Data were collected along three consecutive days and analysed to calculate total variance, standard deviation and the variance attributable to the operator on multiple asymmetry variables. Maximal percentage of variance due to the operator (calculated out of the total variance) was 5.3% and was related to the sensor placed on the head. The results suggest a good reproducibility of IMU-based gait analysis systems for different operators repositioning the system and repeating the same measurements at a succession of time intervals. Future studies will be useful to confirm that inter-operator reproducibility remains valid in larger groups and on horses with different degrees of locomotor asymmetry.

Why cumulative loading calculated using non-weighted integration may not be suitable for assessing physical stress of the lower back: an empirical investigation of strain during lifting and lowering tasks.

When work-related physical stress is assessed using non-weighted integration, it is assumed that different loading conditions have a sufficiently comparable effect on the human body as long as the area under the loading curve is the same. Growing evidence cast doubt on whether this simple calculation can adequately estimate physical work-related strain. This study investigates in vivo, focussing on the lower back, whether the non-weighted method adequately reflects work-related physical strain of the lower back. Strain data resulting from lifting/lowering tasks performed in a laboratory study with an identical area under the loading curve but different load intensities were compared. Results showed that the non-weighted method does not sufficiently reflect the resulting muscular, cardiovascular and perceived strain but underestimates the influence of higher load intensity even in the range of medium physical exposure. Further research is needed regarding the determination of weighting factors and limit values. Practitioner Summary Given the dynamic nature of most physical work activities, the assessment of time-varying loading of the lower back is of particular interest in practice. Results show that the widely used non-weighted calculation method does not accurately reflect the resulting physical strain but underestimates the influence of higher load intensity.Abbreviations: MSD: musculoskeletal disorders; WMSD: work-related musculoskeletal disorders; KIM-LHC: Key Indicator Method Lifting, Holding, Carrying; RES: right erector spinae longissimus; LES: left erector spinae longissimus; HR: heart rate; RPE: rating of perceived exertion; EMG: surface electromyography; ECG: electrocardiography; SENIAM: Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles; MVC: maximum voluntary contraction; ANOVA: analysis of variance; Std. error: standard error HIGHLIGHTSResults of this empirical investigation suggest that the widely used non-weighted calculation method is not fully suitable for calculating cumulative loading of the lower back.Even in the range of medium physical exposure the non-weighted calculation method does not accurately reflect the resulting strain on the human body but tends to underestimate the influence of higher load intensity due to higher external weight.Despite the same cumulative loading value obtained when using the non-weighted method, the resulting physical strain values are generally about 20-25% higher.The results may be used to further develop ergonomic assessment methods in order to avoid a misclassification of loading conditions and to prevent the risk of overexertion.

Musculoskeletal Symptoms in Brazilian University Drummers and Percussionists: A Cross-Sectional Study.

BACKGROUND: In recent years, the number of university drummers and percussionists in Brazil has been increasing. Extensive instrumental practice and repetitive rehearsals are related to the presence of musculoskeletal symptoms among many of these percussion instrumentalists (e.g., repique, tambourine, agogô, rattle, surdo, and snare drums). Musculoskeletal injuries increase the costs of medical exams and treatment in percussionists. OBJECTIVE: The present study aimed to analyze the prevalence of musculoskeletal symptoms in Brazilian university drummers and percussionists. METHOD: An electronic survey addressing demographic features and musculoskeletal signs and symptoms was distributed via social media to university drummers and percussionists in Brazil from July to November 2021. The target sample included university drummers and percussionists over age 18 years, with no gender restrictions, more than 6 months of instrumental practice, and either enrolled in undergraduate studies for more than 1 year or completed undergraduate studies less than 1 year ago. The prevalence and severity of musculoskeletal signs and symptoms were analyzed by body region using the adapted Nordic Musculoskeletal Questionnaire. RESULTS: A total of 103 responses were collected from 2,640 emails sent (3.9% response rate with a 99% completion rate). Sixty participants were female (58.25%). A high frequency of pain and discomfort was reported among the students when participating in battery activities (85.58%). In the last 6 months, wrist/hand was the most involved region (50%), followed by the lower back (45.19%) and shoulders (39.42%). In the last 7 days, the three areas most affected areas when participants were active on the drums were the wrists/hands (75%), shoulders (51.92%), and upper back (33.65%). CONCLUSION: Most Brazilian university drummers and percussionists had experienced musculoskeletal pain. This pain may be related to repetitive movements, inadequate postures, or use of excessive force during performance and practice.

Outcomes of the keystone perforator island flap for oncologic reconstruction of the back.

BACKGROUND: Coverage of posterior trunk defects after tumor resection can be challenging due to the intricate anatomy. The keystone perforator island flap (KPIF) provides coverage of the defect without the need for distant flap coverage or microsurgery, matches the recipient's skin color and contour, and requires a short operative time. METHODS: A retrospective review of all oncological back reconstructions with KPIF was performed at our institution. The patient comorbidities and surgical outcomes were collected. RESULTS: A total of 17 patients underwent 20 KPIF (15 single and 2 double) for back reconstruction. Surgical indications were sarcoma (n = 12) and melanoma (n = 5). The mean age at surgery was 47.3 years (SD 23.3). The flaps were located in the upper back (n = 8), paraspinal (n = 4), middle back (n = 6), and lower back (n = 2). The average wound size after sarcoma and melanoma excision were 231.6 ± 297.4 and 156.7 ± 269.7 cm2 , respectively. Four patients required an additional planned skin graft and one patient underwent a simultaneous myocutaneous latissimus dorsi flap. The mean operative time, including tumor resection, was 256 min (SD 118). The median length-of-hospital stay was 3 days (Q1-3: 1-6.5) and the median follow-up time was 35.3 months (Q1-3: 13.3-53.1). All flaps survived with minor surgical complications which included hematoma (n = 1), surgical site infection requiring debridement (n = 1), superficial wound dehiscence (n = 1), cellulitis (n = 1), and seroma (n = 1). The reconstructions were successful in 100% of patients. CONCLUSIONS: The KPIF is a reliable and safe option for reconstruction of oncological back defects with minimal perioperative complications. This flap option avoids the use of free flaps and myocutaneous flaps for moderate-sized back defects.