SOFT TISSUE RECONSTRUCTION OF THE LOWER EXTREMITY: EVALUATION OF SURGICAL RESULTS IN 15 PATIENTS
Abstract
Introduction: There are general guidelines for reconstruction of complex wounds of the Lower extremity. The goal in treatment of these wounds is to preserve a limb that will be more functional than an amputation.
Material & Methods: In this study, we evaluate our results in 15 patients with extensive wounds in lower extremities (April - 1998 to march - 2001).
Results: The average age of the patients was 31.20 with an age range between 9 to 61 years. Majority of the patients were victims of motor vehicle accident, except two, which developed wounds due to war injury. Distal third of leg was the most common site of trauma and 7 patients had bone fractures, mostly Gustillo III-B. Wound coverage was the most common indication for surgery and free tissue transplantation performed for majority of the patients. Transfer of latissimus dorsi muscle or myocutaneous flap was the most common procedure. One free flap and one fasciocutaneous flap necrosed due to infection and poor technique respectively.
Discussion: Our results revealed that the options for reconstruction of significant soft tissue wounds of the upper and lower thigh are included skin graft, local flap and rarely free tissue transfer. The gastrocnemius muscle or myocutaneous flap serve well for supra-patellar, knee and proximal tibial wounds. The soleus muscle flape is probably the most useful flap in middle tibia However, frequently; wounds of this part are best satisfied by micro vascular tissue transplantation. Soft tissue reconstruction in distal tibia and foot is viewed by many as the most challenging of all lower extremity areas. The vast majority of these wounds are best satisfied by micro vascular tissue transfer. Meanwhile, in cases with a modest skin defect, there is the opportunity to utilize either proximally or distally based fasciocutaneous flaps.
Material & Methods: In this study, we evaluate our results in 15 patients with extensive wounds in lower extremities (April - 1998 to march - 2001).
Results: The average age of the patients was 31.20 with an age range between 9 to 61 years. Majority of the patients were victims of motor vehicle accident, except two, which developed wounds due to war injury. Distal third of leg was the most common site of trauma and 7 patients had bone fractures, mostly Gustillo III-B. Wound coverage was the most common indication for surgery and free tissue transplantation performed for majority of the patients. Transfer of latissimus dorsi muscle or myocutaneous flap was the most common procedure. One free flap and one fasciocutaneous flap necrosed due to infection and poor technique respectively.
Discussion: Our results revealed that the options for reconstruction of significant soft tissue wounds of the upper and lower thigh are included skin graft, local flap and rarely free tissue transfer. The gastrocnemius muscle or myocutaneous flap serve well for supra-patellar, knee and proximal tibial wounds. The soleus muscle flape is probably the most useful flap in middle tibia However, frequently; wounds of this part are best satisfied by micro vascular tissue transplantation. Soft tissue reconstruction in distal tibia and foot is viewed by many as the most challenging of all lower extremity areas. The vast majority of these wounds are best satisfied by micro vascular tissue transfer. Meanwhile, in cases with a modest skin defect, there is the opportunity to utilize either proximally or distally based fasciocutaneous flaps.
Keywords
Lower extremity, Reconstruction, Free flap, Fasciocutaneous flap