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CC BY-NC-ND 4.0 · Indian J Plast Surg 2025; 58(01): 018-027
DOI: 10.1055/s-0044-1791507
Original Article

Bilateral Lower Limb Injuries and the Need for Two Free Flaps: Simultaneous or Sequential

R. Srikanth 
1   Department of Plastic & Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
,
D. Mukunda Reddy
2   Department of Plastic and Reconstructive Surgery, Basavatarakam Smile Train Centre, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
,
R. Parvathi 
1   Department of Plastic & Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
,
Vishal Khasanvis 
1   Department of Plastic & Reconstructive Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
,
P. Chandrashekhar
3   Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, India
› Author Affiliations Funding None.
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Abstract

Objective  To determine the choice of flap cover for patients presenting with bilateral lower limb trauma requiring free flap cover and to derive a step-wise guide to the planning of bilateral lower limb free flaps.

Materials and Methods This was a retrospective study of patients over a 20 year period from 2000 to 2020 who presented with bilateral lower limb defects following trauma and were managed with two free flaps for wound cover, done either simultaneously or sequentially in the same admission.

Results Of the 11 cases with 22 defects, there were 3 re-explorations with 1 flap loss managed with delayed fasciocutaneous flap cover. Donor morbidity was minimal requiring aspiration of seroma for 1 patient and secondary SSG for recipient area graft loss over muscle flap in 2 patients.

Conclusion Use of single donor site ensures economy of time and tissue with the use of skin and muscle chimeric flaps. Harvesting of twin ALT flaps or the use of lattisimus dorsi as one of the flaps requires a 2 stage surgery to avoid prolonged operative time.

Keywords

bilateral - lower limb injury - free flap - ALT-rectus femoris flap - fillet free flap - foot defect


Publication History

Article published online:
01 October 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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