Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

Eva Györi,Annika Resch,Christine Radtke,Thomas Rath,Anna Fast

doi:10.1007/s10353-021-00704-0

Abstract

Summary Background Despite continuous surgical advances, reconstruction of complex lower extremity wounds remains challenging. The indication of local flaps or microsurgical free tissue transfer depends on the anatomical location and size of the defect, as well as the comorbidities and general condition of the patient. In this study, local and free flap reconstruction of distal lower extremity defects was assessed, and postoperative complications and limb salvage were analyzed. Methods A total of 34 patients were included in this retrospective study. Distal lower extremity defects were of traumatic (29%) and non-traumatic (71%) etiologies. Patient characteristics, flap selection, postoperative complications, and limb preservation within the first 12 months were assessed and compared by reconstructive treatment concept. Statistical analysis included parametric and non-parametric tests. The two-sided alpha was set at 5% for all statistical tests. Results While 21 patients were treated with local flaps, 13 patients underwent microsurgical free flap reconstruction. The most common comorbidities were peripheral vascular disease and diabetes. Local flaps included the gastrocnemius muscle flap, soleus flap, sural flap, and plantaris medialis flap. The most commonly used free flaps for soft tissue reconstruction were latissimus dorsi and gracilis muscle flaps. The overall lower extremity preservation rate was 94.1%. There was one case of below-knee amputation 1 month after free flap reconstruction, and one case of first-ray amputation of the foot after local flap coverage. Conclusion Reconstruction of lower extremity defects can be achieved by local or free flap reconstruction. Flap selection is influenced by anatomical location, defect size, and patient factors.

Highlights

Reconstruction of the distal lower extremity remains challenging despite continuous advances in surgical techniques
The mechanisms leading to extensive lower extremity wounds are diverse, including trauma, oncological resection, peripheral arterial disease, diabetes, and chronic venous stasis [2]
The two-sided alpha was set at 5% for all statistical tests

Summary

Introduction

Reconstruction of the distal lower extremity remains challenging despite continuous advances in surgical techniques. Early ambulation, and optimized functional outcomes are therapeutic goals that often require a multistep surgical approach in patients presenting with complex lower extremity defects with exposed vital structures or bones [1]. The mechanisms leading to extensive lower extremity wounds are diverse, including trauma, oncological resection, peripheral arterial disease, diabetes, and chronic venous stasis [2]. The size and anatomical location, as well as the comorbidities and acute state of the patient, are considered in the selection of reconstructive concept [2]. Complex defects in the distal third of the leg with exposed skeletal structures, tendons, nerves, and vessels often require microsurgical free flap reconstruction.

Results

Discussion

Conclusion