Free-flap reconstruction of traumatic lower extremity wounds

A retrospective review of 20 free-tissue transfers for reconstruction of traumatic lower extremity wounds was undertaken. The wounds consisted of Gustilo type IIIb injuries resulting from motor vehicle accidents, falls, motorcycle and four-wheel, all-terrain vehicle accidents, and a laceration from a lawnmower blade. Fifty percent of the procedures were for open tibia fractures. The most common flap used was the rectus abdominis, followed by the latissimus dorsi, serratus anterior, and radial forearm. There were two major complications resulting in flap loss. Adequate and multiple debridements, selection of the appropriate flap, meticulous surgical technique, and postoperative care continue to be the essentials of free-flap coverage. With a motivated patient, limb salvage and return to function can be achieved after most high-energy injuries.