Lower Limb Soft Tissue Research Articles

The Role of Negative Pressure Wound Therapy in Temporizing Traumatic Wounds before Lower Limb Soft Tissue Reconstruction: A Systematic Review.

In practice, there is often a delay from initial debridement and temporary fixation to definitive soft tissue coverage of traumatic leg wounds. Without clear evidence, conservative negative pressure wound therapy (NPWT) is increasingly used to temporize these wounds. This systematic review summarizes and synthesizes the literature on using NPWT to temporize traumatic leg wounds before surgery in adult surgical patients. A comprehensive search of Medline, Embase, and Cochrane Library was performed from inception until July 2022, inclusively. Two independent reviewers performed screening, data extraction, and risk of bias assessment. Primary English studies, including adult patients (≥16 years old) with a fracture below the knee up to and including the ankle that received NPWT to temporize wounds before definitive soft tissue reconstruction with a flap and/or graft, were included. Thirty-four studies, including 804 patients who received NPWT, were included. The partial/total flap loss rate was 6.95% (n = 9 studies), the infection rate was 19.5% (n = 25 studies), the nonunion rate was 18% (n = 15 studies), the delayed union rate was 9.31% (n = 3 studies), and the amputation rate was 15.4% (n = 6 studies). The mean late stay was 43.1 days (n = 9 studies), and the follow-up length was 23.7 months (n = 9 studies). The mean time to wound healing was 5.63 months (n = 2 studies), and the time to soft tissue coverage was 40.8 days (n = 12 studies). The mean time to achieve bone union was 7.26 months (n = 6 studies). NPWT can be used to temporize traumatic wounds while awaiting soft tissue reconstruction.

Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna

BackgroundSelecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity. ObjectiveDemonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps. Materials and methodsCohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)medial tab flap, and group 2)conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications. ResultsThe patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (P=.89).The surgical time for tab flaps was 225.2±117.8minutes, and 191.3±117.2minutes for the comparison flaps (P=.65), there were no statistically significant differences. There were no complications in the medial tab flaps. ConclusionThe findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Cross-leg flaps: A nonmicrosurgical alternative treatment method in complex lower extremity trauma reconstruction.

This study aimed to present our experiences with cross-leg flap surgery, which demonstrates successful outcomes in lower limb soft tissue defects without the necessity of microsurgical intervention. The retrospective study included 26 patients (18 males, 8 females; mean age: 35.6±12.2 years; range, 18 to 65 years) between January 2015 and September 2019. A fasciocutaneous cross-leg flap was applied to the recipient extremity, and the extremities were immobilized by a tubular external fixator. Flap divisions were performed on the 21st postoperative day. At least two years of clinical outcomes were presented. Twenty-five flaps survived and recovered completely without any complication at the donor site, flaps, or the recipient area. In one diabetic patient, partial flap loss was encountered, which granulated with secondary healing. All patients demonstrated stable wound coverage, with none demanding additional soft tissue surgeries. All patients resumed normal ambulation and physical activity without any residual joint stiffness. Cross-leg flap method is an effective and respectable option for extremity salvage as a good alternative to free flaps for the management of traumatic complex lower limb defects. This method is simple, provides abundant blood supply to the wound, and does not require microsurgical experience or a good working recipient artery.

Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review

PurposeTraumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries.MethodsThe electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted.ResultsIn total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen.ConclusionHyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.

Cross-sectional study investigating the relationship between pit recovery time and serum albumin levels in bilateral lower extremity pitting oedema

ObjectivesIn this study, we re-evaluated the relationship between pit recovery time (PRT) and serum albumin levels and elucidated the factors influencing PRT.DesignCross-sectional study.SettingPatients who visited the outpatient department or were...

Comparison of pediatric pelvic fractures and associated injuries caused by different types of road traffic accidents

PurposeTo explore the clinical characteristics of pediatric pelvic fracturs caused by traffic accidents and to analyze the accompanying injuries and complications. MethodsA total of 222 cases involved traffic accidents was enrolled in this case-control study. The data of children with pelvic fractures caused by traffic accidents who were admitted to our hospital from January 2006 to December 2021 were analyzed retrospectively. Sex, age, Tile classification, abbreviated injury scale score, injury severity score, mortality, and accompanying injuries were studied. The ANOVA was used for measurement data, and the non-parametric rank sum test was used for non-normally distributed data. The Fisher's exact probability method was used for the count data. ResultsOf all enrolled cases, 140 are boys and 82 are girls, including 144 aged < 6 years, 65 aged between 6 and 12 years, and 13 aged > 12 years. Depending on the injury mechanism, there are 15 cases involving pedestrians vs. motorcycles (PVM), 91 cases involving pedestrians vs. passenger cars (PVC), 78 cases involving pedestrians vs. commercial vehicles (PVV), and 38 cases involving motor vehicles vs. motor vehicles (MVM). Associated injuries are reported in 198 cases (89.2%), primarily involving the abdomen injury in 144 cases (64.9%), and lower limb injury in 99 cases (44.6%). PVV injury involves longer hospital stay (p = 0.004). Intensive care unit admission rate is significantly higher in the MVM group than in other groups (p = 0.004). Head injury (p = 0.001) and face injury (p = 0.037) are more common in the MVM group, whereas abdominal injury (p = 0.048) and lower limb injury (p = 0.037) are more common in the PVV group. In the MVM group, the brain injury (p = 0.004) and femoral neck injury (p = 0.044) are more common. In the PVM group, the mediastinum (p = 0.004), ear (p = 0.009), lumbar vertebrae (p = 0.008), and spinal cord (p = 0.011) are the most vulnerable regions, while in the PVV group, the perineum (p < 0.001), urethra (p = 0.001), rectum (p = 0.006), anus (p = 0.004), and lower limb soft tissues (p = 0.024) are the most vulnerable regions. Children aged > 12 years have higher pelvic abbreviated injury scale scores (p = 0.019). There are significant differences in the classification of pelvic fractures among children < 6, 6 – 12, and > 12 years of age, with Tile C being more likely to occur in children > 12 years of age (p = 0.033). Children aged > 12 years are more likely to sustain injuries to the spleen (p = 0.022), kidneys (p = 0.019), pancreas (p < 0.001), lumbar vertebrae (p = 0.013), and sacrum (p = 0.024). The MVM group has the highest complication rate (p = 0.003). ConclusionPVC is the leading cause of the abdomen and lower extremities injury and has the most concomitant injuries. Different traffic injuries often lead to different associated injuries. Older children are more likely to sustain more severe pelvic fractures and peripelvic organs injuries. The MVM group has the highest extent of injury and complication rates.

What is the ideal free flap for microvascular lower limb soft tissue reconstruction?

What is the ideal free flap for microvascular lower limb soft tissue reconstruction?

Surgical Experience of Reconstruction of Distal Lower Limb Soft Tissue Defect with Reverse Sural Artery Flap with Cutaneous Pedicle

Background: The soft tissue reconstruction of distal leg, ankle and foot is always challenging to orthopaedic surgeons. Among many available options, the reverse sural artery flap is technically easy local option to cover soft tissue defect. We aim to share our experience of reverse sural fasciocutaneous flaps for reconstruction of distal leg soft tissue defect.&#x0D; Materials and Methods: An observational retrospective study was conducted on all cases that had undergone reverse sural flap surgery between February 2019 to January 2023 in orthopedic department of Nobel Medical College Teaching Hospital. The following variables were gathered for analysis: hospital stay duration, postoperative complications, etiology and duration of the wound, wound site and size, number of surgeries, associated trauma, surgery time and technical details, and final outcome in terms of flap survival.&#x0D; Results: Out of 20 cases, sixteen were male and 4 were female. The mean age was 36 years. Seven cases (35%) had associated comorbidities. The most common etiology was trauma and most common sites was ankle and calcaneus (60%) followed by distal leg (35%) and foot (5%). The graft survival rate was 85%. Three cases (15%) had partial flap necrosis and one (5%) had venous congestion.&#x0D; Conclusion: The reverse sural artery flap is easy, versatile and reliable technique to cover soft tissue defect in distal leg, ankle and foot.

Prophylactic lymphedema surgery in lower limb soft tissue sarcomas: A clinical paradigm in a promising field

IntroductionOncological treatments, such as radiotherapy and surgery, are high-risk factors for the development of secondary lymphedema in the upper and lower limbs, as well as the genitalia. Prophylactic lymphedema surgery (PLS) has previously demonstrated promising results in reducing secondary lymphedema in breast cancer and urogenital cancer patients. We conducted a study to adapt this principle for patients with lower extremity sarcomas. Material and MethodsInclusion criteria included patients with tumors on the medial aspect of the thigh and leg, tumor size larger than 5cm. Group A (19 patients) comprised a prospective cohort (2020-2023) in which a PLS protocol was executed. Lymphaticovenous anastomosis (LVA) was performed when lymphatic channels were interrupted due to tumor resection, intraoperatively verified by indocianine green (ICG). Lymph node transfer (LNT) was employed exclusively in cases involving preoperative radiotherapy and inguinal lymph node resection. Measurements were collected both preoperatively and at 1, 3, 6, and 12 months postoperatively. Group B (26 patients) constituted a retrospective cohort (2017-2020) without PLS reconstruction, where the prevalence of lymphedema was determined. ResultsIn total, we enrolled 45 patients with soft tissue sarcomas located on the inner aspect of the thigh and leg (26 in the control group vs. 19 in the prophylactic group). In the control group, lymphedema was observed in 10 out of 27 patients (37.04%). In the prophylactic group, two patients exhibited signs of lower extremity lymphedema (2/19, 10.52%) with a median follow-up of 14.15 months (6 months - 33months), demonstrating statistically significant differences between the two groups (p=0.02931). ConclusionsPLS for lower limb soft tissue sarcomas shows promising results, although it is premature to reach solid conclusions. Multicenter studies, standardization of criteria, larger sample sizes, and longer-term follow-up are imperative for further validation.

Treadmill Deck Performance Optimization Design Based on Muscle Activity during Running

In previous research on treadmills, the main focus has been on comparing the physiological differences induced by running on treadmill decks and other exercise surfaces, with relatively little research on the mechanical properties of treadmill decks. Reducing sports injuries is a common desire of runners, which may be closely related to muscle activity. Obviously, the mechanical properties of the treadmill play an important role in this process. Muscle activity was evaluated based on a mass-spring-damper (MSD) model that provides a simulated signal of the ground reaction forces (GRF) and vibration of the lower-limb soft tissues (LLST) during the landing of the human body during running. We improved the original human motion model by considering the stiffness and damping effect of the treadmill deck. In addition, based on the theory of muscle activity regulation, the dimensionless objective function is established, and the particle swarm optimization algorithm is used to find the best range of treadmill deck parameters under pre- and post-fatigue conditions. The results show that the hardness of the treadmill deck can affect the regulation of muscle activity. Based on this, the parameters of the specific safe area of the treadmill deck are obtained, and the size of the safe area after fatigue is significantly reduced compared to that before fatigue. By studying the physiological effects of the mechanical properties of the treadmill deck on runners, the research results are expected to provide references for the design of treadmill deck parameters and reduce the risk of runners’ sports injuries, which has practical application value for treadmill design and runners’ health.

Wound Coverage Considerations for Leg Defects: Our Experience

Abstract Background: Lower limb injuries are common and account for 40-50% of emergency department visits. These injuries occur frequently in poly-trauma, which remains a leading cause of long hospitalization, disability and death for all ages. Clinical treatment of these injuries poses a great challenge because the surgeons need to face serious complications such as shock, wound coverage and infection, and has to choose a right time to deal with the combined fractures and injuries of the blood vessels, nerves and tendons. The aim of this study is to study clinical profile and management of various below knee soft tissue injuries. Methods: This study was conducted in two tertiary care centres of Northern India. Subjects were recruited from patients presenting in Emergency/Surgery OPD, a primary diagnosis of lower limb soft tissue injuries. Results: A total of 125 patients with lower limb injuries were included in the study. Different treatment options were individualized and exercised which included skin grafting (49.6%), flap coverage (44%) primary closure (4.8%) and skin substitutes like Integra (1.6%). While in 46 wounds (36.8%) negative pressure wound therapy (NPWT) VAC was used. It was observed that 92 patients (73.6%) underwent surgery only once whereas 33(26.4%) patients had to undergo surgery 2 or more times. Conclusion: The aim of surgical treatment in lower limb reconstructions is maximum limb functional recovery and return to work activities. Problems in reconstruction are mainly encountered in the ankle and lower third leg defects because, local tissue availability is very minimal in these areas.

Soft tissue coverage of the ankle: An algorithm for appropriate flap selection and the experiences of a newly established Major Trauma Network

IntroductionReplication of the thin and pliable native skin around the ankle remains a challenge for plastic surgeons treating soft tissue defects in this region. Flap reconstruction constitutes the mainstay of management of such injuries. Subsequent management often entails revisional debulking surgery to permit normal footwear and an acceptable aesthetic outcome. In light of limited elective operating capacity throughout the covid-19 pandemic, we adopted an algorithm to inform reconstruction in such injuries and limit the need for revisional surgeries. This study presents this algorithm, which considers patient age, functional status, co-morbidities, body habitus and defect location. MethodsRetrospective analysis of a prospectively maintained database of all patients undergoing lower limb soft tissue reconstruction over 21 months was performed. All flap-based reconstructions of ankle defects were included; direct closures and skin grafts were excluded. All trauma patients were managed via a combined orthoplastic approach as per BOA-BAPRAS standards. All patients had Computed Tomography Angiography prior to their definitive reconstruction. Lower Extremity Functional Scale (LEFS) scores were analysed for patients with over 12 months of postoperative follow up, where available. Results71 flaps were performed in 69 patients. Open ankle fracture was the most common cause (86%); other indications included osteomyelitis and surgical wound dehiscence. Mean age was 50 (13–87 years) with a higher proportion of males to females (ratio 1.25:1). There were 26 pedicled flaps (18 Medial Plantar Artery and 8 Peroneus Brevis) and 45 free flaps (22 Anterolateral thigh, 11 Superficial Circumflex Iliac Artery Perforator, 11 Gracilis and 1 Medial Sural Artery Perforator). Mean follow-up is 13.6 months. There were three flap failures, and four patients subsequently underwent delayed below knee amputation despite successful soft tissue healing. For the patients with a minimum of 12 months follow up, LEFS scores with an average of 51% were achieved (range 15–88%). Four patients have been listed for revisional/debulking surgery. ConclusionAlthough soft tissue defects around the ankle can be difficult to manage, with careful planning and addressing each patient individually, supported by an algorithmic approach, good functional and aesthetic outcomes can be achieved with low rates of secondary revision surgery.

Postoperative drainage management and wound complications following resection of lower limb soft tissue tumors: a retrospective cohort study

PurposePostoperative wound complications are common in patients undergoing resection of lower extremity soft tissue tumors. Postoperative drainage therapy ensures adequate wound healing but may delay or complicate it. The aim of this study is to evaluate the incidence of postoperative wound complications and delayed or prolonged drainage treatment and to propose a standardized definition and severity grading of complex postoperative courses.MethodsA monocentric retrospective analysis of 80 patients who had undergone primary resection of lower extremity soft tissue tumors was performed. A new classification was developed, which takes into account postoperative drainage characteristics and wound complications. Based on this classification, risk factors and the prognostic value of daily drainage volumes were evaluated.ResultsAccording to this new definition, regular postoperative course grade 0 (no wound complication and timely drainage removal) occurred in 26 patients (32.5%), grade A (minor wound complications or delayed drainage removal) in 12 (15.0%), grade B (major wound complication or prolonged drainage therapy) in 31 (38.8%), and grade C (reoperation) in 11 (13.7%) patients. Tumor-specific characteristics, such as tumor size (p = 0.0004), proximal tumor location (p = 0.0484), and tumor depth (p = 0.0138) were identified as risk factors for complex postoperative courses (grades B and C). Drainage volume on postoperative day 4 was a suitable predictor for complex courses (cutoff of 70 ml/d).ConclusionThe proposed definition incorporates wound complications and drainage management while also being clinically relevant and easy to apply. It may serve as a standardized endpoint for assessing the postoperative course after resection of lower extremity soft tissue tumors.

Lower Limb Soft Tissue Mass in a Newborn

Lower Limb Soft Tissue Mass in a Newborn

Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs

Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps. Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients' general information, smoking history, soft tissue defect site, Gustilo-Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors. Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate-to-severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886-36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731-29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343-65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924). The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate-to-severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.

Free flaps for lower limb soft tissue reconstruction – A systematic review of complications in ‘Silver Trauma’ patients

BackgroundThere are 12.5 million people aged 65 years and older living in the UK. The annual incidence of open fracture is 30.7 per 10,000 person-years. In females, 42.9% of all open fractures occur in patients ≥ 65 years. Methods and materialsPreferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study is registered with PROSPERO (CRD42020209149). The aim was to compare the complication profiles of free fasciocutaneous flaps and free muscular flaps in patients aged over 60 years undergoing lower limb soft tissue reconstruction following an open lower limb fracture. The search strategy based on strict inclusion criteria included PubMed, Embase and Google Scholar. Results15 papers were identified, including 46 patients with 10 free fasciocutaneous flaps and 41 free muscle flaps. There were 3 complications in the fasciocutaneous group (30%) and 9 complications in the muscle group (22%). There was a total of 1 secondary procedure in the fasciocutaneous group and 4 in the muscle group. DiscussionThere is insufficient data to provide statistical comparison between free fasciocutaneous versus free muscle flaps for lower limb reconstruction performed in those aged over 60 years. This systematic review highlights evidence for the successful use of free tissue transfer in the older population following an open fracture injury and requiring lower limb reconstruction. There is no evidence to suggest the superiority of one tissue type over the other, with the inference that well vascularised tissue is the most significant factor impacting outcome.

Lower limb soft tissue reconstruction using free ALT flaps: multimodal parameter analysis to predict the level of spontaneous reinnervation

Introduction This work aims to assess lower limb free flaps spontaneous sensory recovery by comparing and analyzing a single standardized reconstructive procedure, namely the free noninnervated anterolateral thigh (ALT) flap in order to evaluate which flap or patient-related factors may predict flap reinnervation. Methods Between January 2010 and March 2018 all nonreinnervated ALT flaps for lower limb coverage performed at our institution were screened. We excluded from the study flaps with less than 18 months of follow-up time, neurotized flaps, and those from patients who missed the last follow up. Sensory modalities that were evaluated included the two-point discrimination (2PD) test, measured in mm; and the Semmes–Weinstein monofilament (SWM) test, measured in gram. The sensory parameter results were compared and analyzed according to flap size (two groups; <160 cm2 vs. > 160 cm2), and post-op time of testing (two groups; <18–28 months vs. > 28 months). Results Twenty-one ALT free flaps were finally retained by this study. Our findings showed that flaps of smaller surface area showed a significantly better return in sensory discrimination 2PD and in sensory cutaneous pressure perception SWM testing. Conclusion This work establishes for the first time some key quantitative data that can help predict free flap spontaneous reinnervation outcomes when using the same ALT flap. In our series, flaps surface remains the main discriminant value for a better sensory recovery.

Management of a patient with necrotizing soft tissue infection complicated by sepsis. An authors’ experience

The authors describe their experience in a successful treatment of a patient with necrotizing infection of lower limb soft tissues complicated by sepsis. Their comprehensive approach included two-stage surgical intervention and medicamentous therapy. As a result, the patient has completely recovered.

Sport and exercise medicine approach to acute lower limb soft tissue injury management in the emergency department.

Sport and exercise medicine approach to acute lower limb soft tissue injury management in the emergency department.

Fasciocutaneous flaps in the lower limb soft tissue reconstruction – A surgical case series

Traumatic injuries, metabolic, vascular and malignant diseases are among the main causes of soft tissue defects in the lower limb. The limited tissue resources and the peculiarities of the blood supply make reconstructive treatment a challenge. Various modalities of fasciocutaneous flaps have been gaining popularity in the treatment of soft tissue defects in the lower extremity. A retrospective analysis including a group of 19 patients with soft tissue defects in the lower limb, treated in the period June 2019–July 2021 in the Department of Burns and Plastic Surgery, UMHATEM “N. I. Pirogov” was conducted. Twenty fasciocutaneous flaps were performed (6 - Keystone flaps, 6 - Reverse flow Sural flaps, 4 - Perforator Propeller flaps, 2- V–Y perforator flap, 2 - Axial Rotation flap). Demographic and clinical data is analyzed. Functional (LEFS) and aesthetic evaluation (POSAS 2.0) of the achieved results is obtained. Patients were of both sexes, aged between 23 and 78 years. All of the flaps survived. Minor complications occurred in 3 cases. Significant functional improvement and satisfactory aesthetic results were reported. Free tissue transfer, considered as the “gold standard” in the reconstruction of complex defects involving the lower limb, has its drawbacks. Fasciocutaneous flaps are a good alternative option to free flaps. They are characterized by good functional results and rare complications. Utilization of the fasciocutaneous flap strategy is a reliable method for ensuring the integrity and the function of the lower limb. • Fasciocutaneous flaps can be used reliably in lower limb soft tissue reconstruction. • Respect to the perforasomes is crucial. • Greatest mobility has the sural flap. • Perforator propeller flaps are capable of transferring largest amount of tissue. • Significant functional improvement and satisfactory aesthetic results are reported.