Surgical options in the repair of lower-extremity soft-tissue wounds

Until very recently complex soft-tissue defects of the leg and foot were closed with local tissue, cross-leg flaps, or staged distant flaps. Free vascularized tissue transfer and muscle and musculocutaneous flaps have expanded the surgical options substantially. During the past 5 years, we have been involved in the closure of 60 complex lower-extremity wounds. Methods of repair included local skin flaps, standard cross-leg flaps, free flaps, and muscle and musculocutaneous flaps. Every wound and patient should be considered individually. The ankle region and the sole of the foot remain the most difficult areas to resurface. Based on our experience we list preferred methods of soft-tissue repair for various lower-extremity subregions. Type of operation may also be influenced by patient age and sex.