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Semin Plast Surg 2022; 36(04): 233-242
DOI: 10.1055/s-0042-1758205
Review Article

Approach to Complex Lower Extremity Reconstruction

David Cholok
1   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
,
Ean Saberski
2   Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
David W. Lowenberg
3   Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, California
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Abstract

Composite injuries to the lower extremity from etiologies including trauma and infection present a complex dilemma for the reconstructive surgeon, and require multidisciplinary collaboration amongst plastic, vascular, and orthopaedic surgical specialties. Here we present our algorithm for lower-extremity reconstructive management, refined over the last decades to provide an optimized outcome for our patients. Reconstruction is predicated on the establishment of a clean and living wound, where quality of the wound-bed is prioritized over timing to soft-tissue coverage. Once established, soft-tissues and fractures are provisionally stabilized; our preference for definitive coverage is for microvascular free-tissue, due to the paucity of healthy soft-tissue available at the injury, and ability to avoid the zone of injury for microvascular anastomosis. Finally, definitive bony reconstruction is dictated by the length and location of long-bone defect, with a preference to utilize bone transport for defects longer than 5 cm.

Keywords

negative pressure wound therapy - fractures - lower extremity


Publication History

Article published online:
16 November 2022

© 2022. Thieme. All rights reserved.

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