Subscribe to RSS
DOI: 10.5999/aps.2013.40.5.575
Reconstruction of the Lower Extremity Using Free Flaps
Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction.
Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications.
Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts.
Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.
Publication History
Received: 29 May 2013
Accepted: 10 July 2013
Article published online:
01 May 2022
© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th FloorFloor, New York, NY 10001, USA
-
References
- 1 Gottlieb LJ, Krieger LM. From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg 1994; 93: 1503-1504
- 2 Pollak AN, McCarthy ML, Burgess AR. Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. The Lower Extremity Assessment Project (LEAP) Study Group. J Bone Joint Surg Am 2000; 82: 1681-1691
- 3 Melissinos EG, Parks DH. Post-trauma reconstruction with free tissue transfer: analysis of 442 consecutive cases. J Trauma 1989; 29: 1095-1102
- 4 Percival NJ, Sykes PJ, Earley MJ. Free flap surgery: the Welsh Regional Unit experience. Br J Plast Surg 1989; 42: 435-440
- 5 Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1986; 77: 785-794
- 6 Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and random-pattern flaps. Plast Reconstr Surg 1982; 70: 1-10
- 7 Mathes SJ, Alpert BS, Chang N. Use of the muscle flap in chronic osteomyelitis: experimental and clinical correlation. Plast Reconstr Surg 1982; 69: 815-829
- 8 Sofiadellis F, Liu DS, Webb A. et al. Fasciocutaneous free flaps are more reliable than muscle free flaps in lower limb trauma reconstruction: experience in a single trauma center. J Reconstr Microsurg 2012; 28: 333-340
- 9 Basheer MH, Wilson SM, Lewis H. et al. Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg 2008; 61: 525-528
- 10 Bowen V, Manktelow RT. Complications and unsatisfactory results in the microsurgical reconstruction of lower extremities. Microsurgery 1993; 14: 196-202
- 11 Chen HC, Chuang CC, Chen S. et al. Selection of recipient vessels for free flaps to the distal leg and foot following trauma. Microsurgery 1994; 15: 358-363
- 12 Godina M, Arnez ZM, Lister GD. Preferential use of the posterior approach to blood vessels of the lower leg in microvascular surgery. Plast Reconstr Surg 1991; 88: 287-291
- 13 Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers. Plast Reconstr Surg 1979; 64: 673-682
- 14 Frodel JL, Trachy R, Cummings CW. End-to-end and endto-side microvascular anastomoses: a comparative study. Microsurgery 1986; 7: 117-123
- 15 Samaha FJ, Oliva A, Buncke GM. et al. A clinical study of end-to-end versus end-to-side techniques for microvascular anastomosis. Plast Reconstr Surg 1997; 99: 1109-1111
- 16 Germann G, Steinau HU. The clinical reliability of vein grafts in free-flap transfer. J Reconstr Microsurg 1996; 12: 11-17
- 17 Small JO, Mollan RA. Management of the soft tissues in open tibial fractures. Br J Plast Surg 1992; 45: 571-577