Free flaps for reconstruction of the lower extremity

Experience with the use of free flaps for lower extremity reconstruction during the period 1973 to 1980 is reviewed. From 1973 to 1977, 12 groin and 2 deltopectoral flaps were used, with 8 successes and 6 failures. From 1978 to 1980, 19 myocutaneous flaps (15 latissimus dorsi, 3 tensor fascia lata, and 1 osteocutaneous groin flap based on the deep circumflex vessels) were performed, 17 successfully and 2 unsuccessfully. The reasons for the improved results seem to be the longer and bigger vascular pedicle, the use of more end-to-side arterial anastomoses, and the choice of arterial trunks that are more distal and easier to work with. For these reasons, myocutaneous free flaps are the flap of choice for microsurgical soft tissue reconstruction of the lower limb.