Present Review and Surgical Considerations for Lower Leg Reconstruction

Introduction: More than three decades, Department of plastic surgery and burns in Ljubljana presents a surgical epitaph for lower leg reconstruction.

All practical and theoretical parts are precised as meticulous debridement of soft tissues and bone in the zone of injury, by fracture stabilization by either external or internal fixation, by assuring good circulation with a direct artery repair or by the use of venous or arterial grafts, and by closure of the soft-tissue defect with a suitable free flap with microvascular anastomoses (Godina et al). Later, it was evident by results, that emergency treatment of complex lower leg injuries gives predictably better results that delayed treatment.

Methodology and Material: In last five years (2007 - 2012), an emergency treatment dropped down, while a soft tissue defect after a bone fixation undergo to treatments, as a special dressings, permanent dermal xenografts, VAC drainage and hyperbaric oxygenation by orthopedic surgeons. Delayed defect is smaller and sinkless, what needs suitable flap, as m. serratus free flap, even gracilis flap instead of latissimus dorsi free flap.

Results: At present, plenty of aged patients, with angiographic examined occlusive vascular disease, indicate a use of a local or distant axial pedicle flap. In some cases, innovated suralis flap completed on peroneal perforators was harvested. On upper third of lower leg, the best solution is a single or double gastrocnemius transfer to cover exposed patella or even joint or protrusion of functional or tumor prosthesis.

Respecting propeller flaps, short-term results are acknowledged as advantages. Long term results are not still precisely evaluated in comparison to free flaps. In our routine praxis we realize, that an absence of microanastomosis on bigger vessels cannot jeopardize an important vascularization and viability of a lower extremity.

Sometimes, an amputation, as a part of reconstructive ladder, seems to be better solution, as a high number of operations or long hospitalization.

Conclusions: However, a repair must be individually adapted to new conditions and surgical requests. Finally, a restore of soft tissue, requires active cooperation between orthopaedic and plastic surgeon and organization of a continuous microsurgical service.