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
