[Repair of complex wounds of the lower limb]

The prognosis of complex open fractures of the lower limbs has radically been altered by recent advances in plastic surgery. Numerous reliable flaps are now available, including muscular, musculo-cutaneous, fascio-cutaneous and septo-cutaneous flaps with a proximal or distal pedicle, and free cutaneous, osseous, osteo-cutaneous etc. microsurgical transfers. Whether homo- or hetero-lateral, these flaps provide an efficient treatment in almost every case. Microsurgery is usually the best method for effective covering of losses of substance that are extensive and/or located in the middle or distal third of the limb. In emergency surgery as well as in surgery of sequelae, the therapeutic indications must be thoroughly discussed.