Reconstruction of the lower extremity

Lower extremity trauma may result in loss of skin and/or muscle and expose critical structures such as bone, tendon or blood vessels.  These structures require soft tissue coverage to prevent infection and further complications.  Sometimes following surgical stabilization of bones, the implant(s) may become exposed and this situation similarly requires soft tissue coverage to prevent infection of the implant, bone and surrounding tissue.  Expedient wound management minimizes many downstream complications and your best care is found in private hospitals, where ample facilities and resources are available to facilitate this.

How does it manifest?

Lower extremity trauma often presents in the acute setting at the Emergency Department where the wounds are noted in conjunction with the bony fractures.  The skin and muscles may be lost due to the accident and resulting in exposed critical structures.  Less commonly, the blood vessels of the extremity may also be lost at the time of the accident, resulting in absent blood supply to the downstream (distal) portion of the extremity.

Lower extremity trauma wounds may also occur as a result of wound infection following fracture fixation.  The wounds may be non-healing, resulting in exposed implant(s).  These require tissue coverage to prevent bacterial colonization of the implant, and extension of infection into the fracture site.

When is lower extremity reconstruction performed?

The timing of reconstruction is dependent on the nature of the injury.  The timing of reconstruction may include:

  • Emergency. In traumatic injury cases where the blood vessels are disrupted, blood flow to the downstream (distal) portion of the extremity needs to be reconnected urgently.  This may be achieved by using vein grafts, prosthetic grafts, or where a concurrent soft tissue defect exists, a distant flap incorporating its blood vessels as a flow-through conduit.
  • Early (within 1 week). In traumatic injury cases where there is no blood vessel disruption, preliminary surgery is performed to clean up the wound and bony stabilization prior to reconstructive soft tissue coverage.  The reconstructive procedure is ideally performed within 1 week to cover the critical structures and minimize possibility of wound infection.

Lower extremity trauma reconstruction: Restoring form and function

Lower extremity reconstruction is performed together with a partnering orthopedic surgeon.  Wound debridement (removal of infected and nonviable tissue) and bony stabilization is performed.  There may an occasional need to perform investigations to ascertain the health of the blood vessels supplying the extremity such as angiography or Duplex ultrasonography.  Successful reconstruction outcomes are often possible after the infection has been cleared from the wound.  Depending on the anatomical location of the defect, size and depth, a variety of skin grafts, regional or distant flaps may be performed for its coverage.

What is the postoperative recovery like?

Most individuals will require a short hospital stay following the surgery.  Weightbearing of the injured extremity is dependent on the stability of the fracture and its fixation, and postoperative physical therapy and rehabilitation.  Stitch removal is performed at around the 21st postoperative day.

What is the postoperative care like?

Smokers are advised to for cessation of smoking for at least 3 weeks postoperatively to minimize the possibility of complications relating to delayed wound healing.  Skin grafts and flaps placed over mobile areas such as joints will require a short period of immobilization until they are fully healed.

The Picasso Advantage

The lower extremity has locomotive, psychological and aesthetic functions.  Extremity preservation is of significant importance and successful reconstruction is a keystone in its salvage.  Dr Yeo is experienced in the field extremity preservation.  He completed a fellowship in Advanced Microsurgical Reconstruction under Professor Hung-Chi Chen, one of the international pioneers and leaders in extremity salvage.  He has since performed many successful cases of extremity salvage in Singapore since completion of his fellowship.