Abstract
Background
Goals of lower extremity microvascular reconstruction (LEMR) include the restoration
of function, prevention of infection, and optimal cosmesis. Indications for LEMR include
large defects that are not amenable to pedicled options, a large zone of injury, and
large complex defects. The novice microsurgeon should first master a handful of free
flaps to develop an armamentarium of options for addressing such defects. The scope
of this review is to provide free flap options for LEMR in any of the thirds of the
lower leg. After reading this article, the reader will understand variations, advantages,
disadvantages, indications, and tips for raising each of these flaps.
Methods
Six most commonly used free flaps for LEMR are described in this paper, including
the anterolateral thigh flap (ALT) and its variations, the radial forearm flap (RFFF),
the lateral arm flap (LAF), the gracilis muscle flap, the rectus abdominis flap (RAF)
and the latissimus dorsi flap and its variations. Indications, advantages, disadvantages
and technique tips are discussed for each flap. Moreover, selection of the recipient
vessels, preoperative management along with an algorithm are also provided.
Conclusions
The ALT flap is a workhorse in covering defects of the leg, foot, and ankle. It's
the flap of choice at our institution, especially given the number of traumatic wounds
seen as a result of motor vehicles, all-terrain vehicles (ATV), lawnmowers, and gunshot
wounds (GSW). At times, the lower extremity zone of injury requires a distant donor
site. The RAF can also provide coverage for large soft tissue defects but donor-site
morbidity remains its main drawback. The LAF and RFFF provide two pliable options,
one that provides pliable soft tissue with minimal donor site morbidity and another
that provides a long pedicle. The free gracilis flap is an excellent choice for crossing
the ankle joint. Lastly, the free latissimus dorsi is indicated for large defects
of the lower extremity independently of the location.
Keywords
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Article info
Publication history
Published online: October 21, 2019
Footnotes
This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
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© 2019 Elsevier Ltd. All rights reserved.
