Reconstruction of Soft - Tissue Defects in the Lower Extremities Using Local or Free Muscle Flaps

Cho, Hong Kyu; Lee, Dong Jin; Cha, Jin Han; Kim, Yang woo

Abstract

According to increment of industrial accidents and traffic accidents, complex injuries of the lower extremity accompanied with broad soft-tissue defects. Lower extremity possess disadvantageous anatomical characteristics includes poor vascularity easily result in compromised circulation, rigid tissue distensibility, easy infectability followed by soft-tissue defects and relatively long healing periods. Furthermore, it easily happens that osteomyelitis or non-union was followed by bony exposure or fractures, and it must considered to weight-bearing or gate. So, It is impotant to select a appropriate method in reconstruction of the lower extremities and it is applicable to variety of surgical techniques according these considerations. The goal of flap coverage in the lower extremity should be not only satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. The Authors estimated that skin graft and local flap surgery for bony exposed area and soft-tissue defect in weight- bearing area may not be successful. In this article, we have tried to established a reconstruction method in the lower extremity based on experiences and clinical analyses of reconstruction of the soft-tissue defects using local or free muscle flap transfer in 54 cases(49 patients) from 1993.3 to 2000.2. Results revealed 93% flap survival, but there were flap failure noted in 4 cases: one appears in the local muscle flap transfer, other three appear in the free muscle flap transfer. Among the 49 patents, 28 patients(58%) accompanied with open comminuted fractures and 11 patients (22%) visited us with infection. We think that soft-tissue defects in lower extremities associated with open comminuted fractures and infections should be reconstructed by flaps that include healthy muscles effectively due to benefits of muscle itself.