Reconstruction of the lower extremity

The lower extremities are objects of function and beauty.  They provide balance, locomotion and sensation, all of which are critical to a good quality of life.  The lower extremities also have an intrinsic aesthetic appeal and should be proportionate to the trunk.  Extremity preservation and salvage may be successfully achieved in many cases and is important for preservation of function and psychological well-being.  Extremity salvage also facilitates mobility, rehabilitation and social integration.

When is lower extremity reconstruction required?

Common clinical indications for lower extremity reconstruction and salvage include the following:

  • Traumatic injuries
  • Sarcomas and soft tissue tumours of the extremities
  • Diabetic foot ulcers and wounds

Reconstruction of the Lower Extremity: Skin Grafts, Distant, Local & Regional Flaps

What are the techniques used in lower extremity reconstruction?

Skin grafts

Skin grafts may be harvested as split-thickness or full-thickness skin grafts and common donor sites for skin grafts are the thighs and back.  Skin grafts “heal” to the underlying wound bed within 1 to 2 weeks.  During this interval, the blood vessels from the wound bed grow into the skin grafts and provide them with their permanent blood supply.  Because of the necessity for ingrowth of blood vessels to sustain the tissue, skin grafts are always thin and are suitable for covering shallow defects.

Local and regional flaps

Flaps are tissues that are harvested from a donor site and moved to a recipient site with its intact blood supply.  This permits the harvest of thicker pieces of tissue, as well as tissue composites to resurface complex and deep defects.  Local and regional flaps are usually performed for a wide range of small-to-medium sized defects in the thigh, leg and ankle.  Flaps heal to the adjacent wound bed within 2 to 3 weeks.  It uses tissue that is adjacent or nearby the defect and has similar properties (thickness, contour and pigmentation) and has a good blood supply.

Distant flaps

Distant flaps are flaps that are harvested from a donor site that is anatomically remote from the recipient site with its intact blood vessels.  Distant flaps are normally used where no local or regional tissue is available, or where the wound defects are large and complex.  This may include harvesting flaps from the back and the upper and lower extremities.  Following flap harvest, the blood vessels that supply the flap will need to be connected to blood vessels in the vicinity of the defect using microsurgical techniques, where ultra-fine sutures that are thinner than a strand of hair are used.  Successful outcomes are possible in the vast majority of cases and require careful preoperative planning, precise technical execution and an experienced practitioner.

Dr Matthew Yeo, Picasso Plastic Surgery, Team Nurses, Singapore Aesthetic & Cosmetic