Free groin-flap transfer for skin defects associated with orthopaedic problems of the lower extremity

Seventeen patients with full-thickness skin loss complicating orthopaedic problems of the lower part of the leg and the foot underwent free groin-flap transfer. Free flaps were used because more conventional means of coverage had failed or were deemed inappropriate. Nine patients had uncomplicated one-stage flap transfer. Three had peripheral necrosis but required no further procedures. Five patients had superficial necrosis of more than one-fourth of the flap, but split-thickness skin grafts applied to the viable subdermal portion of the flap provided an adequate surface in all but one of them. Necrosis was considered to be a result of anastomosis to scarred recipient vessels or of unexplained vessel thrombosis. It may be circumvented in part by the use of interposed vein grafts, or proximal extension of the flap along the recipient vascular tree.