Aims: Acquired defects of the back primarily are the result of radiation injury, trauma, tumour ablation, or wound dehiscence and infection. The incidence of these defects is growing, since the demand of spinal operations for degenerative spinal diseases and tumour resections is increasing. The reconstructive techniques for posterior trunk defects have improved, because of the use of muscle ßaps. When there are extensive wounds, free ßap reconstruction may be the only option to assure durable coverage. We wanted to evaluate the outcome of these patients. Methods: We review our series of these reconstructions. Results: 16 patients with difþcult wounds of the posterior trunk were treated with various ßaps. The causes of posterior trunk defects were a post operative wound dehiscence or infection (13), tumour (2), meningomyelocele (1). Mean follow-up period was 63 months. The wound location was cervical area (4), upper and midthoracic area (3), lower thoracic and thoracolumbar area (5), lumbosacral area (2), and sacral area (2). The defects were closed by fasciocutaneous ßaps (3), musculocutaneous trapezius ßaps (4), trapezius muscle ßap (1), latissimus dorsi muscle ßap (1), paraspinous muscle ßaps (3), and gluteus muscle ßap (1). In addition, three patients underwent microvascular transfer of the latissimus dorsi muscle. The exposed orthopedic hardware could be left in place in þve out of seven cases. The muscle ßaps did not cause any major functional deþcit in the donor sites. Conclusions: A high rate of success is obtained in the management of posterior trunk defects with muscle ßaps. Adequate debridement of all devitalised tissues and coverage with well vascularized tissue to obliterate any residual dead space and to cover orthopedic hardware are mandatory and prerequisite.