Combining Historic and Modern Concepts: How the Delay Phenomenon Enhances Propeller Flap Success in Large Dorsolumbar Soft Tissue Reconstruction.

The authors present a novel 2-staged approach for complex dorsolumbar wound reconstruction in a multioperated spine patient with limited local flap options and contraindications for free flap reconstruction due to arteriosclerosis and cardiac issues. A delayed dorsal propeller flap was first autonomized to enhance perfusion, followed by elevation and mobilization 4 weeks later. This approach combined the historic delay phenomenon with modern propeller flap techniques, achieving durable coverage and infection control. The case highlights the value of integrating traditional and innovative surgical methods for complex reconstructions.