Background: Lower limb defects following compound fractures are a major cause of morbidity following trauma. Local reconstructive options are often limited necessitating microvascular free flap reconstruction.

Materials and Methods: A retrospective evaluation of all patients undergoing microvascular free flap reconstruction for post-traumatic lower limb defects from January 2011 to December 2014 at a tertiary health care centre was performed. All patients were evaluated for etiology, site of the defect, free flap used, recipient vessel, type of anastomosis, flap survival and post-operative complications.

Results: Of all the 22 patients evaluated with a mean age of 27.7 years (range 8-66 years), 18 were males and 4 females. Road traffic accident was the major mode of trauma (18 patients) followed by railway accident (2), fall from height (1), assault (1). Flaps used were ALT flaps (14), Latissimus Dorsi (6), gracilis (2). Most common site of defect was lower third leg (15) followed by middle third leg (2), foot and sole (5). Fasciocutaneous flaps were done in 14 patients and muscle flaps were done in 8 patients. The overall survival rate was 90.90% (20/22) with partial necrosis in 2 patients. End to end anastomosis was done in 18 patients and end to side anastomosis was done in 4 patients.

Conclusions: Microvascular free flaps are an integral part of treatment for post-traumatic lower limb defects. Excellent outcomes can be achieved by thorough debridement, appropriate recipient vessel and flap selection and careful post-operative management.

Keywords: Lower limb defects, free flap, muscle flaps, fasciocutaneous flaps.

1. Engel, Holger, Lin, Chih-Hung, Wei, Fu-Chan: Role of Microsurgery in Lower Extremity Reconstruction : J of Plastic and Reconstructive Surgery 2017 Jan; 127:228-238.
2. Kennith mattox; TRAUMA; seventh edition:
3. Outcome Comparison between Free Muscle and Free Fasciocutaneous Flaps for Reconstruction of Distal Third and Ankle Traumatic Open Tibial FracturesYazar, Sukru; Lin, Chih-Hung; Lin, Yu-Te; More; Plastic and Reconstructive Surgery. 117(7):2468-2475, June 2006.
4. Reddy V, Stevenson TR. MOC-PS(SM) CME article: lower extremity reconstruction. Plast Reconstr Surg 2008;121(4, Suppl):1–7.
5. Evans K, Clemens M, Salgado C, Moran S, Mardini S. Fasciocutaneous versus muscle flap in soft tissue reconstruction. In: Pu LLQ, Levine JP, Wei F-C, eds. Reconstructive Surgery of the Lower Extremity, Part II. Chap. 22. St. Louis, USA: QMP; 2013:345–368.
6. Yildirim S, Gideroğlu K, Aköz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 2003;19(04):225–233.
7. Ozkan O, Coşkunfirat OK, Ozgentaş HE. The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities. Ann Plast Surg 2004;53(05):455–461.
8. Yazar S, Lin CH, Lin YT, Ulusal AE, Wei FC. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg 2006;117(07):2468–2475, discussion 2476– 2477.
9. Paro J, Chiou G, Sen SK. Comparing muscle and fasciocutaneous free flaps in lower extremity reconstruction - does it matter? Ann Plast Surg 2016;76(03, Suppl 3): S213–S215.
10. Lin CH, Mardini S, Wei FC, Lin YT, Chen CT. Free flap reconstruction of foot and ankle defects in pediatric patients: long-term outcome in 91 cases. Plast Reconstr Surg 2006;117(07): 2478–2487.
11. Park JE, Rodriguez ED, Bluebond-Langer R, et al. The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J Trauma 2007;62(01):162–165.
12. Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002;109(07):2219–2226, discussion 2227–2230.
13. End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes, J reconstr Microsurg 2017; 33(06): 402-411.

Dr Amarnath Munoli

4^th Floor Room Number 450 College Building Department of Plastic Surgery Sion Hospital Mumbai 400022