Changes in donor site selection in lower limb free flap reconstructions

Area of Science:

• Microsurgery
• Plastic Surgery
• Reconstructive Surgery

Background:

• Over 1,000 free flap reconstructions performed since 1973.
• Primary focus on head and neck, breast, and limb surgeries.
• Lower leg reconstructions show evolving indications based on anatomical understanding and flap adaptability.

Purpose of the Study:

• To analyze the evolution of free flap reconstruction indications in lower leg surgery.
• To highlight the importance of donor site morbidity reduction and site preservation.
• To discuss the expanding applications of free flaps in complex lower leg and foot reconstructions.

Main Methods:

• Review of over 1,000 free flap cases performed since 1973.
• Analysis of changing indications for flap selection in lower leg reconstructions.
• Evaluation of factors influencing flap choice, including anatomical developments and flap adaptability.

Main Results:

• Indications for lower leg free flap selection have evolved beyond initial soft tissue and bone coverage.
• Improved understanding of muscle and fascial free flaps has broadened their application.
• Free flaps are increasingly used for chronic infected ulcers, osteomyelitis, diabetic wounds, and pressure sores.
• Foot reconstruction and restoration of weight-bearing capacity present significant challenges.

Conclusions:

• Free flap reconstruction techniques have advanced, offering solutions for complex lower leg defects.
• Optimizing flap selection is crucial for minimizing donor site morbidity and preserving resources.
• The scope of free flap applications in the lower leg has expanded to address a wider range of challenging wound etiologies.