ABSTRACT
Lower extremity reconstruction presents the plastic surgeon with complex problems of not only form, but also of function. The use of free-tissue transfer is clearly indicated in salvageable limbs with massive soft tissue or bony loss. Prior to performing a free-tissue transfer repair, the surgeon must first evaluate the patient’s overall candidacy for surgery. Mangled limbs with extensive soft-tissue injury and loss may not be candidates for functional salvage. In severe lower extremity wounds, the use of plates or intramedullary nails is precluded by the inability to provide adequate and stable soft-tissue coverage. By shortening the limb, the size of the soft-tissue defect may decrease enough to allow for a smaller flap to be used. When considering options for soft-tissue reconstruction following trauma, one must first consider locoregional solutions. Prior to consideration of soft-tissue reconstruction, lower extremity revascularization should be undertaken. The microsurgical armamentarium has facilitated limb salvage in patients following resection of neoplasms of the lower extremity.
