Extremity preservation in traumatic and nontraumatic lower extremity defects

Indications for reconstruction of the lower extremity range from posttraumatic defects to infections and tumors. Despite advancements in plastic surgery, flap surgery still poses a challenge. In this retrospective study local flap surgeries and microsurgical free flaps were assessed. Postoperative complications and limb preservation were analyzed.

This retrospective study included 187 patients who were treated at a university-affiliated tertiary care hospital. Defects were of traumatic (29.4%) and nontraumatic (70.6%) etiology. Limb preservation was determined during a 12-month follow-up period. Patient characteristics, flap selection and postoperative flap-associated complications were collected.

The patient population included 107 men (57.2%) and 80 women (42.8%), 104 (55.6%) free flaps and 83 (44.4%) local flaps were performed. In the free flap group latissimus dorsi and gracilis flaps were most commonly performed. The most common surgeries in the local flap group were gastrocnemius, soleus and plantaris medialis muscle flaps. The overall limb preservation rate was 92.5% with no significant difference between the two groups.

Both methods enable reconstruction of complex lower extremity wounds and enable limb preservation in many cases. The type of flap is selected based on the anatomical location of the defect, defect size and patient factors.