Reconstruction of complex mid back wounds is challenging due to the patient comorbidities and scarcity of reliable regional flap alternatives. Four consecutive cases treated with perforator based V-Y advancement flaps are reported. An effective repair was achieved in all the patients and the mean follow up period was 28 months. Our results indicate the efficacy of adipocutaneous flaps in complex spinal soft tissue repair and may help to refine the relevant algorhythm. (C) 2011 Wiley-Liss, Inc. Microsurgery 31:229-233, 2011.