Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

Abstract

Summary Background Despite continuous surgical advances, reconstruction of complex lower extremity wounds remains challenging. The indication of local flaps or microsurgical free tissue transfer depends on the anatomical location and size of the defect, as well as the comorbidities and general condition of the patient. In this study, local and free flap reconstruction of distal lower extremity defects was assessed, and postoperative complications and limb salvage were analyzed. Methods A total of 34 patients were included in this retrospective study. Distal lower extremity defects were of traumatic (29%) and non-traumatic (71%) etiologies. Patient characteristics, flap selection, postoperative complications, and limb preservation within the first 12 months were assessed and compared by reconstructive treatment concept. Statistical analysis included parametric and non-parametric tests. The two-sided alpha was set at 5% for all statistical tests. Results While 21 patients were treated with local flaps, 13 patients underwent microsurgical free flap reconstruction. The most common comorbidities were peripheral vascular disease and diabetes. Local flaps included the gastrocnemius muscle flap, soleus flap, sural flap, and plantaris medialis flap. The most commonly used free flaps for soft tissue reconstruction were latissimus dorsi and gracilis muscle flaps. The overall lower extremity preservation rate was 94.1%. There was one case of below-knee amputation 1 month after free flap reconstruction, and one case of first-ray amputation of the foot after local flap coverage. Conclusion Reconstruction of lower extremity defects can be achieved by local or free flap reconstruction. Flap selection is influenced by anatomical location, defect size, and patient factors.

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

“…Defect aetiology varied greatly between and inside the selected studies including traumatism, neoplasm, infections, scar contractures, and chronic wounds (with peripheral vascular disease, irradiation, and neuropathy). Complete flap necrosis was reported in all 10 articles and the pooled analysis did not find a significant difference between FF and PF (RR 1.35, 95%CI 0.76-2.39, p = 0.31) [12][13][14][15][16][17][18][19][20][21]. (Figure 2) A partial flap failure was reported in eight articles and FF had a significantly lower risk than PF in the pooled analysis (RR 0.45, 95%CI 0.22-0.91, p = 0.03) [12][13][14][15][16][18][19][20] (Figure 3).…”

“…Complete flap necrosis was reported in all 10 articles and the pooled analysis did not find a significant difference between FF and PF (RR 1.35, 95%CI 0.76-2.39, p = 0.31) [12][13][14][15][16][17][18][19][20][21]. (Figure 2) A partial flap failure was reported in eight articles and FF had a significantly lower risk than PF in the pooled analysis (RR 0.45, 95%CI 0.22-0.91, p = 0.03) [12][13][14][15][16][18][19][20] (Figure 3). Overall complication rates were reported in six studies, and the pooled analysis found no significant difference between FF and PF concerning the overall risk of complications (RR 0.83, 95%CI 0.64-1.07, p = 0.16) [13,15,16,[19][20][21] (Figure 4).…”

“…(Figure 2) A partial flap failure was reported in eight articles and FF had a significantly lower risk than PF in the pooled analysis (RR 0.45, 95%CI 0.22-0.91, p = 0.03) [12][13][14][15][16][18][19][20] (Figure 3). Overall complication rates were reported in six studies, and the pooled analysis found no significant difference between FF and PF concerning the overall risk of complications (RR 0.83, 95%CI 0.64-1.07, p = 0.16) [13,15,16,[19][20][21] (Figure 4). For Yuan et al's work, a vascular crisis was not counted as a complication, as it was defined as a clinical sign motivating surgical exploration.…”

“…After being screened by title and abstract, only 19 studies were considered eligible for complete reading. Ten studies met all the selection criteria [12][13][14][15][16][17][18][19][20][21] (Figure 1).…”

“…Only adverse outcomes from this surgical exploration were accounted in the overall complication rate [19]. Revision surgery rates were reported in five studies, and no significant difference in risk was found between FF and PF (RR 1.38, 95%CI 0.55-3.50, p = 0.49) [13,15,16,19,21] (Figure 5). Revision surgeries were reported for functional purposes such as skin grafting, debridement, etc.…”