Background: The number of patients with midline back wounds is increasing. Midline back wounds may cause skin and soft tissue defects, resulting in cavity formation and bone or orthopedic metallic hardware exposure. These complexities complicate coverage of the wounds. This study aimed to determine whether a perforator-based pedicled (island) flap was useful for the coverage of midline back wounds.Methods: After debridement of the wound, flaps were designed, dissected and inset into the midline wounds. The donor site was closed primarily. If the wound was too large to be covered with a unilateral flap, another flap at the contralateral site was used. Immediate and early postoperative position changes were made.Results: Between May 2011 and November 2019, 13 patients with skin and soft tissue defects of the midline back underwent coverage with perforator-based pedicled fasciocutaneous flaps. All flaps survived. Though flap tip necrosis and/or wound dehiscence occurred in five patients, total flap necrosis was not observed. Immediate postoperative position change was possible, allowing the patient to avoid flap ischemia.Conclusion: The perforator-based pedicled fasciocutaneous flap can be a useful option for covering midline back wounds with skin and soft tissue defects.