The Preferred Reconstructive Choice for a Lower Third Tibial Exposure Defect: An Online Survey of 356 Microsurgeons

Abstract

Background One of the most challenging yet common areas in reconstructive surgery is the closure of defects in the lower leg. Surgeons have can choose from several reconstructive options options for the closure of soft tissue defects of the lower leg, including local and free flaps. The aim of this study was to understand the reconstructive strategy for lower leg defects of different microsurgeons around the world by harnessing the power of social media and online questionnaires. Methods A studied case of a patient with an exposed plate over distal tibial fracture was presented via an online questionnaire distributed on various social media platforms. 369 international microsurgeons replied with their preferred treatment choice. The data were analysed according to geographic area, microsurgical training, seniority, and subspecialty. Results Among all the respondents (n=369), 64% would have opted for a free flap reconstruction, while the remaining 36% would have opted for a local/pedicle flap. In the group that would have opted for a free flap, 63% would reconstruct the defect using a free fasciocutaneous flap, while the remaining 37% would have used a free muscle flap. In the local flap group, 60% would have used a local perforator while 30% would have chosen a conventional local flap. While North American and European microsurgeons had a clear preference towards free flaps, Asian, Middle Eastern, African and South American surgeons were evenly divided between local and free flaps. Conclusion In this study, we provide a current global overview of the reconstructive strategies for a lower limb with skin defect and bone or prosthesis exposure. We hope that this will be able to help global microsurgeons and patients worldwide.

Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol

“…18 Although some surgeons consider free tissue transfer a standard treatment option, controversies persist regarding wounds in the distal third of the leg that are either too small for free flap surgery or too large for primary suturing. 21,22 The increasing pattern of using fasciocutaneous perforator flaps provides more alternatives for lower limb reconstruction. 20,23 In our study, we have developed an algorithm influenced by previous studies and known management protocols, and taking into account the available services and materials.…”