Microvascular Lower-Limb Salvage: A General Surgeon's Perspective

Managing large soft tissue defects with or without bone loss in the lower limb is quite a demanding task. A good knowledge of the different microvascular options for lower limb salvage can greatly assist the general surgeon in optimizing patient care.

The author reported earliest experience with free tissue transfer for lower limb salvage in the department of General Surgery, Alexandria University School of Medicine. Thirteen patients with major soft tissue defects, following either trauma or cancer extirpation, were presented. There were 9 males and 4 females whose ages ranged from 8 to 63 years.

The free flaps used were as follows: six latissimus dorsi, one TRAM, three radial forearm, one fibula, and two anterolateral thigh flaps. Partial flap loss occurred in 2 patients and total flap loss occurred only in one patient, following secondary hemorrhage from the pedicle on the 12th post operative day.

When a general surgeon is both the ablative and reconstructive surgeon, preparation of the recipient area is much improved with several options for the recipient vessels, thus simplifying the subsequent reconstruction.