Abstract
Purpose Complex lower extremity wounds present a significant challenge to the reconstructive
surgeon. We report a consecutive experience of free tissue transfers for lower extremity
reconstruction with a focus on outcomes and flap selection.
Methods A retrospective review of all free tissue transfers for lower extremity reconstruction
between 2006 and 2011 was performed. Minor complications were defined as nonoperative
complications (infection, seroma, hematoma, wound breakdown, and partial loss). Major
complication required a surgical intervention (total flap loss, thrombosis, nonunion,
amputation, and hematoma).
Results A total of 119 free flaps were performed in 114 patients. Reconstructed defects were
most commonly derived from acute traumatic (N = 40) or chronic traumatic (N = 34) wounds, oncologic (N = 14), or diabetic (N = 8). Flap loss occurred at a rate of 5.9% and the overall lower extremity salvage
rate was 93%. Complications were significantly higher for free tissue transfers to
the region of the distal tibia (p = 0.04). Major complications were significantly higher in patients with chronic obstructive
pulmonary disease (p = 0.02) and in patients who experienced intraoperative technical difficulties (p = 0.014). Flap loss was significantly higher when the rectus abdominis flap was used
(p = 0.02) and when a delayed venous thrombotic event occurred (p = 0.001).
Conclusion Patient comorbidities and defect location can be associated with higher rates of
complications; flap selection and delayed venous thrombotic events appear to be associated
with flap failure.
Level of Evidence Prognostic/risk category, level III
Keywords
lower extremity - free flap - outcomes
