What is the ideal free flap for microvascular lower limb soft tissue reconstruction?

Abstract

Objectives: is to detail four reliable free flaps including the anterolateral thigh, radial forearm, thoracodorsal and latissimus dorsi for use in lower extremity microvascular reconstruction and to establish factors to consider when developing an algorithm for reconstructing lower extremity injuries. Background: to achieve restoration of normal functions and good aesthetic outcomes ; microvascular free flaps are the preferred method for complex injuries repair in lower limbs. Methods: A total of 30 patients with complex soft tissue lower limb defects and deformities required surgical reconstruction were enrolled in this study. They underwent four types of free flap reconstruction. All patients were followed up post-operatively for a period of up to 1 year. Results: This study was carried out on 30 patients with extensive defects in lower limb their ages varied from 6 to 49 years (mean age was 27.7 years). There were 20 males (66.6 %) and 10 females (33.4 %), tobacco smoking was identified in 6 cases (20 %) and 3 cases (10 %) known to be diabetic patients. Four reliable free flaps had been used to cover the extensive soft tissue defects including the anterolateral thigh flap latissimus dorsi flap in 10 cases (33.4 %), radial forearm in 5 cases (16.6 %), and thoracodorsal in 5 cases (16.6 %). Posterior tibial vessels were the recipient vessels in 18 patients (59, 9%) and anterior tibial vessels were the recipient vessels in 12 patients (40 %) (P = 0.013). Conclusion: Microsurgeons should develop mastery of a relatively few free flaps to help in optimal soft tissue lower limb reconstruction. We described four options of free flaps that cover most of lower limb defects.