Salvage Reconstruction of Lower Extremity Defects With Muscle Flaps

Abstract

Summary: The management of lower extremity wounds has changed as reconstructive options have broadened. Free tissue transfer has enabled salvage of limbs that would have previously been amputated. At the same time, development of new local flaps has allowed successful reconstruction of wounds without the need for microsurgery. Additionally, vacuum-assisted closure therapy has dramatically impacted wound care and facilitated complex wound closure without the need for flaps (DeFranzo et al. Plast Reconstr Surg 2001;108:1184–1191). As surgical techniques have improved, the need for surgical salvage of lower extremities has concomitantly increased. The lives of multi-trauma patients, whether after a motor vehicle accident or wartime injury, are preserved at higher rates, producing more medically stable individuals with salvageable extremities. As cancer treatment improves, quality of life becomes a more important consideration, and limb-preserving surgery is more frequently expected. This article discusses methods of reconstructing complex lower extremity wounds. Surgical techniques, and anatomically based descriptions of commonly used flaps, are outlined. Perioperative management of these reconstructed extremities is also detailed.