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Bilateral Lower Limb Injuries and the Need for Two Free Flaps: Simultaneous or Sequential
R Srikanth1, D Mukunda Reddy2, R Parvathi1
1Department of Plastic & Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India.
Summary
This study analyzed free flap reconstruction for bilateral lower limb trauma. Single donor sites with chimeric flaps offer efficiency, while twin ALT or latissimus dorsi flaps necessitate staged procedures.
Area of Science:
- Reconstructive Microsurgery
- Trauma Surgery
- Limb Reconstruction
Background:
- Bilateral lower limb trauma presents complex reconstructive challenges.
- Free flap reconstruction is a critical option for extensive lower limb defects.
Purpose of the Study:
- To guide the selection of flap coverage for bilateral lower limb trauma.
- To develop a planning strategy for bilateral lower limb free flaps.
Main Methods:
- Retrospective analysis of 11 patients (22 defects) from 2000-2020.
- Evaluation of free flap reconstruction (simultaneous or sequential).
Main Results:
- Three re-explorations and one flap loss occurred, managed with delayed fasciocutaneous flap.
- Minimal donor site morbidity; two patients required secondary split-thickness skin grafts (SSG).
Conclusions:
- Single donor sites with chimeric flaps optimize time and tissue.
- Harvesting twin anterolateral thigh (ALT) flaps or using latissimus dorsi requires staged surgery to prevent prolonged operative times.
