Abstract
Soft tissue defects of the lower extremity that expose underlying bones, joints, and
tendons pose challenging problems and generally require free tissue transfer for a
successful reconstruction. Historically, muscle flaps were the gold standard choice
for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site
morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator
flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive
scenario. There is growing evidence in the literature supporting that fasciocutaneous
and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative
infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge
in perforator anatomy and their mapping, a new era of lower limb reconstruction has
begun. Propeller flap could be raised on any suitable perforator vessel and, without
the aid of microsurgical anastomosis, used to restore small- to middle-sized soft
tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous
free flaps and the applicability of the propeller flaps in lower limb reconstruction.
Keywords
lower limb reconstruction - free flaps - muscle flaps - fasciocutaneous flaps
