Lower extremity soft tissue reconstruction with free flap based on subscapular artery

Area of Science:

• Orthopedic Surgery
• Plastic Surgery
• Microsurgery

Background:

• Lower extremity defects often result from trauma or burns.
• Reconstruction of these defects is crucial for restoring function and form.
• Free flaps offer a versatile solution for complex tissue defects.

Purpose of the Study:

• To evaluate the efficacy of free flaps utilizing the subscapular artery system for lower extremity reconstruction.
• To assess the outcomes and potential complications associated with these reconstructive procedures.

Main Methods:

• A retrospective review of 51 patients who underwent lower extremity reconstruction using subscapular artery-based free flaps between 1998 and 2008.
• Analysis of defect location, etiology, flap type, and vascular anastomosis techniques.
• Evaluation of early and late postoperative complications and functional outcomes.

Main Results:

• Latissimus dorsi muscle flaps were the most common (53%), followed by serratus muscle/fascia (21%) and parascapular fasciocutaneous flaps (14%).
• Posterior tibial artery and foot dorsal veins were the most frequent recipient vessels (80%).
• Early complications included venous (4 patients) and arterial/venous occlusion (1 patient), and partial necrosis (2 patients), all managed with re-anastomosis or further treatment. Late ulcerative lesions occurred in 4 patients.

Conclusions:

• Subscapular artery-based free flaps provide optimal vascularity and minimal donor site morbidity, representing a safe and effective reconstructive option.
• Cross-leg free flaps can be a viable alternative when recipient vessels are compromised.
• These flaps are a reliable choice for complex lower extremity reconstructions.