Reconstruction of the Lower Extremity Using the Various Flap Operations

Ahn, Ki Young; Lee, Seung Hwan; Song, Chul Hong

Abstract

There are some difficulties in the reconstruction according to anatomic regions of the lower extremity such as thigh, knee, anterior tibia, heel and so on. The earlier the normal tissue saved and the necrotic tissue removed, the less the patients had complications and functional disability. There are many kinds of flap surgery in the reconstruction of the lower extremity such as local skin flap, local fasciocutaneous flap, local muscle flap and free flap. We have done 71 cases using the various flap operation excluding direct closure and skin graft among the patient of lower extremity injury from Jul. 1997 to Oct. 2002. Among 71 cases, 46 cases were due to traffic accidents and mechanical damages and 4 cases were burn, 5 cases were diabetic ulcer, 16 cases were cancer and other skin defects. Lower leg and foot were the most common lesion and the next was knee and thigh. And in the flap operations we have done, 32 cases(45%) were local skin flap, 18 cases(25%) were local fasciocutaneous flap, 6 cases(9%) were local muscle flap, 15 cases(21%) were free flap and so on. In early postoperative complications, the total flap necrosis was seen in 1 case, the partial necrosis in 6 cases, the infection in 5 cases and the hematoma or seruma in 3 cases. The bulky flap and ulceration were seen in 3 cases respectively and needed secondary operation after long term follow-up. The area below the knee joint is limited by its low vascularity, low tissue flexibility, high infectiousness and long periods of wound healing, and the reconstruction of the weight bearing heel needs proper skin thickness and durability. The better reconstruction of the lower extremity needs many experiences of various methods to us and we should know about their advantages and disadvantages.