Limb salvage without microsurgery: a 1-year case series of regional flaps in a resource-limited setting

Soft tissue defects of the lower limb, commonly resulting from high-energy trauma, complicate fracture management by increasing infection rates and delaying union. When critical structures such as bone, tendons, joints, or neurovascular bundles are exposed, flap coverage - either free or regional - is essential. In resource-limited settings, regional flaps are often performed by orthopedic surgeons due to limited access to plastic surgeons and microsurgical equipment. This study presents a 1-year experience of lower limb flap coverage performed by orthopedic surgeons at a tertiary hospital in Tanzania.

We conducted a retrospective review of patients who underwent regional flap procedures for lower limb soft tissue defects following trauma between January 2024 and December 2024. Data regarding demographics, defect characteristics, flap type, hospital stay, and complications were obtained from operative records and patient files.

A total of 21 patients were included in the study. The majority were males (71.4%) and aged between 21 and 45 years. The most common defect location was the distal leg and ankle (38.1%), followed by the proximal leg or knee (33.3%). Reverse sural flaps were the most frequently used (38.1%), followed by gastrocnemius (28.6%) and soleus (19.1%) flaps. Cross-leg flaps and combined flaps were used in select cases. The average hospital stay was 33 days. Postoperative complications included peripheral flap necrosis (four patients) and recipient site infections (four patients), primarily affecting reverse sural and soleus flaps.

Limb salvage procedures may help reduce the long-term socioeconomic burden of major limb loss in our settings, given the high cost of prosthetic rehabilitation and the significant social stigma associated with amputation in Tanzania. However, delayed coverage contributes to prolonged hospital stays and higher complication rates. Strengthening early flap interventions and microsurgical capacity may improve outcomes.