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Selecting a free flap for soft tissue coverage in lower extremity reconstruction.

S D Kozusko¹, X Liu¹, C A Riccio¹

¹Department of Plastic Surgery, University of Tennessee Health Science Center Memphis, TN, 38163, USA.

|November 13, 2019

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This review details six free flaps for lower extremity microvascular reconstruction (LEMR), aiding surgeons in selecting optimal options for complex leg defects. Understanding flap variations, pros, and cons is crucial for successful outcomes.

Area of Science:

Plastic Surgery
Orthopedic Surgery
Microsurgery

Background:

Lower extremity microvascular reconstruction (LEMR) aims to restore function, prevent infection, and improve cosmesis.
Indications include large defects, extensive injury zones, and complex wounds unsuitable for pedicled options.
Novice microsurgeons benefit from mastering a core set of free flaps for versatile defect coverage.

Purpose of the Study:

To review free flap options for lower extremity microvascular reconstruction (LEMR) across all thirds of the leg.
To detail variations, advantages, disadvantages, indications, and surgical tips for each flap.
To guide surgeons in selecting appropriate free flaps for diverse lower extremity defects.

Main Methods:

Review of six commonly used free flaps for LEMR: anterolateral thigh (ALT), radial forearm (RFFF), lateral arm (LAF), gracilis, rectus abdominis (RAF), and latissimus dorsi.

Keywords:

Anterolateral thigh flap (ALT)Gracilis muscle flap Lateral arm flap (LAF)Latissimus dorsi flap Lower extremity microvascular reconstruction Radial forearm flap (RFF)Rectus abdominis flap (RAF)

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Discussion of indications, advantages, disadvantages, and technique tips for raising each flap.

Inclusion of recipient vessel selection, preoperative management, and a decision-making algorithm.

Main Results:

The anterolateral thigh (ALT) flap is highlighted as a versatile option for leg, foot, and ankle defects, particularly traumatic ones.
The rectus abdominis flap (RAF) offers coverage for large defects but has associated donor-site morbidity.
Other flaps like LAF, RFFF, gracilis, and latissimus dorsi provide specific benefits such as pliable tissue, long pedicles, ankle joint crossing, or coverage for extensive defects.

Conclusions:

The ALT flap is a preferred choice for many lower extremity defects due to its versatility and effectiveness, especially in trauma.
Different free flaps, including RAF, LAF, RFFF, gracilis, and latissimus dorsi, offer tailored solutions for specific defect characteristics and locations.
Effective LEMR relies on understanding the nuances of each flap to achieve optimal functional and aesthetic restoration.