Our clinical experience with lower extremity defect closure

Lower extremity soft tissue reconstruction is one of the main fields in plastic and reconstructive surgery. During the past 30 years, developments in wound care technologies and microsurgical techniques led to a remarkable change in lower ekstremity reconstruction practice. However, no consensus exists, regarding the ideal defect closure method according to the localization and content of defect. This study aims at defining an up-to-date algorithm including novel techniques, for lower limb soft tissue reconstruction, guided by our clinical experience and literature review. Patients operated on for lower extremity soft tissue defects between January 2000 and January 2014 at plastic and reconstructive surgery clinic of Gaziantep University Faculty of Medicine were retrospectively analyzed through hospital records. Patient demographics as age and sex, aetiology, location of defect, technique used for defect closure, complications and revision surgeries were noted. Retrospective review revealed a total of 590 patients, as 418 males (71 %) and 172 females (29 %), were operated for lower extremity defects. 128 patients were under the age 16 (21,69 %). Road traffic accidents were the leading aetiological factor both in adults and children. A total of 790 operations were performed on 590 patients, hence 52 of the patients had more than one operation. 54 of 590 patients had multiple defects and the total number of defects in this study was780. These 780 defects were reconstructed via 790 operative techniques. Skin grafts were found to be the most common closure method regardless of the location of defect. Most of those defects not eligible for graft closure were successfully reconstructed with local random fasciocutaneous flaps. Local axial pattern fasciocutaneous flaps, local muscle flaps and free flaps were used as required in decreasing order. Lower extremity defects, especially those resulting from high energy trauma and those located distally, constitutes a challenge for the reconstructive team. A functionally and aesthetically successful reconstruction is only possible, provided an appropriate patient selection and surgical plan is conducted and the reconstructive ladder is precisely evaluated. A novel reconstructive algorithm, including recent surgical techniques, is presented at the end of this study. Key words: Algorithm, Flap, Graft, Lower extremity, Lower extremity defect, Soft tissue reconstruction.