"External Fixation Tower" for Lower Extremity Microvascular Reconstruction With All-around Protection and...

This ideas and innovations report addressed a novel method of "external fixation tower" for the postoperative management of lower extremity free flap reconstruction. Traditional splinting methods often fail to accommodate the complex shape of the reconstructed foot and maintain proper limb positioning, which is insufficient to secure flap safety, and can lead to complications such as equinus contracture and pressure ulcers. We present a case of a 73-year-old man with a diabetic gangrene over the right Achilles tendon and heel who underwent free latissimus dorsi myocutaneous flap transfer, using the Hoffmann 3 external fixation system for postoperative management. The external fixation tower provided complete circumferential protection of the foot, including vascular anastomotic site, total pressure offloading, and elevation of the flap. It simultaneously served multiple functions, including ankle joint fixation to prevent equinus contracture and heel offloading to prevent pressure ulcers, and provided a platform for gauze placement beneath the flap. The postoperative course was uneventful. As the postoperative flap perfusion stabilized, the configuration of the external fixator was progressively simplified, and rehabilitation was done while wearing it. In lower extremity reconstruction using free flaps, postoperative management with external fixation of Hoffmann 3 system provides all-around protection, allows for adaptive morphological modifications based on the clinical situation, and enables rehabilitation and ambulation while wearing it. The method is considered not only to reduce various postoperative complications and lessen the burden on doctors and nurses for postoperative care but also to produce favorable outcomes.