Semin Plast Surg 2003; 17(1): 069-082
DOI: 10.1055/s-2003-39857
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Lower Extremity Reconstruction

L. Scott Levin, Christoph Heitmann
  • Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, NC
Further Information

Publication History

Publication Date:
16 June 2003 (online)

ABSTRACT

The advent of reconstructive microsurgical techniques has enhanced the outcome in patients who present for lower limb salvage. Free tissue transfer is now routine, and indications include reconstruction following trauma, tumor resection, and osteomyelitis. In addition, patients with dysvascular and diabetic foot problems as well as amputees with unstable residual limbs benefit from microvascular surgery. The authors discuss the impact of microsurgery on all of these indications and provide insight into future technologies.

REFERENCES

  • 1 Gopal S, Majumder S, Batchelor A G, Knight A L, De Boer P, Smith R M. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia.  J Bone Joint Surg . 2000;  82B 959-966
  • 2 Greene T L, Beatty M E. Soft tissue coverage for lower extremity trauma: current practice and technique.  J Orthop Trauma . 1988;  2 158-173
  • 3 Heller L, Levin L S. Lower extremity reconstruction.  Plast Reconstr Surg . 2001;  108 1029-1042
  • 4 Heller L, Levin L S. Bone and soft tissue reconstruction. In: Bucholz RW, Heckman JD, eds. Rockwood and Green's Fractures in Adults Philadelphia, PA: Lippincott 2001: 415-462
  • 5 Jacobson J H, Suarez E L. Microsurgery in anastomosis of small vessels.  Surg Forum . 1960;  11 243-244
  • 6 Tornetta P, Olson S A. Amputation versus limb salvage.  Instr Course Lect . 1997;  46 511-518
  • 7 Tomaino M M, Bowen C W. Unsatisfactory outcome after lower limb salvage: decision making pitfalls.  Am J Orthop . 1998;  27 526-529
  • 8 Gustilo R B, Merkow R L, Templeman D. Current concepts review: the management of open fractures.  J Bone Joint Surg . 1990;  72A 299-304
  • 9 Fischer M D, Gustilo R B, Varecka T F. The timing of flap coverage, bone grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft tissue injury.  J Bone Joint Surg . 1991;  73A 1316-1322
  • 10 Godina M. Early microsurgical reconstruction of complex trauma of the extremities.  Plast Reconstr Surg . 1986;  78 285-292
  • 11 Hallock G G. Utility of both muscle and fascia flaps in severe lower extremity trauma.  J Trauma . 2000;  48 913-917
  • 12 Patzakis M J. Management of acute and chronic osteomyelitis. In: Chapman MW, ed. Chapman's Orthopaedic Surgery Philadelphia, PA: Lippincott 2001: 3533-3560
  • 13 Attinger C E, Bulan E, Blume P A. Surgical debridement. The key to successful wound healing and reconstruction.  Clin Podiat . 2000;  17 599-629
  • 14 Zenn M R, Levin L S. Microvascular reconstruction of the lower extremity.  Semin Surg Oncol . 2000;  19 272-281
  • 15 Barwick W J, Goldberg J A, Scully S P, Harrelson J M. Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection.  Ann Surg . 1992;  216 591-595
  • 16 Gutman M, Kaplan O, Skornick Y, Klausner J M, Lelcek S, Rozin R R. Gangrene of the lower limbs in diabetic patients: a malignant complication.  Am J Surg . 1987;  154 305-308
  • 17 Oishi S N, Levin L S, Pederson W C. Microsurgical management of extremity wounds in diabetics with peripheral vascular disease Plast Reconstr Surg .  1993;  92 485-492
  • 18 Briggs S E, Banis J C, Kaebnick H, Silverberg B, Acland R D. Distal revascularization and microvascular free tissue transfer: an alternative to amputation in ischemic lesions of the lower extremity.  J Vasc Surg . 1985;  2 806-811
  • 19 Kuentscher M V, Erdmann D, Homann H H, Steinau H U, Levin L S, Germann G. The concept of fillet flaps: classification, indications and analysis of their clinical values.  Plast Reconstr Surg . 2001;  108 885-896
  • 20 Shenaq S M, Krouskop T, Stal S, Spira M. Salvage of amputation stumps by secondary reconstruction utilizing microsurgical free tissue transfer.  Plast Reconstr Surg . 1987;  79 861-870
  • 21 Yamamoto N, Nakai H, Satoh Y, Oshima Y. Clinical application of a non-penetrating microvascular stapling device for vascularized free tissue transfer.  Ann Plast Surg . 1999;  42 49-55
  • 22 Shenaq S M, Klebuc M J, Vargo D. Free tissue transfer with the aid of loupe magnification: experience with 251 procedures.  Plast Reconstr Surg . 1995;  95 261-269
  • 23 Seletti J M, Deuber M A, Guidera P M. Comparison of the operating microscope and loupes for free microvascular tissue transfer.  Plast Reconstr Surg . 1995;  95 270-276
  • 24 Morrison W A, Dvir E, Doi K, Hurley J V, Hickey M J, O'Brien B M. Prefabrication of thin transferable axial-pattern skin flaps: an experimental study in rabbits.  Br J Plast Surg . 1990;  43 645-654
  • 25 Khouri R K, Koudsi B, Reddi H. Tissue transformation into bone in vivo: a potential practical application.  JAMA . 1991;  266 1953-1955
  • 26 Khouri R K, Upton J, Shaw W W. Principles of flap prefabrication.  Clin Plast Surg . 1992;  19 763-771