A STUDY OF LOWER EXTREMITY RECONSTRUCTION

BACKGROUND: The reconstruction of the lower extremity poses a great challenge because of the complexity of the injuries. Road traffic accidents are the most common cause of mortality and morbidity in patients. High speed traffic accidents result in a variety of associated life- threatening injuries. Lower extremity poses problems of wound healing and also the lack of suitable donor local flaps. The development of Microsurgical techniques in the past 25 years has changed the whole spectrum of reconstruction of the lower limbs. AIMS AND OBJECTIVES: The aim of this study is to evaluate the use of various flaps in the lower extremity reconstruction in a tertiary care center. The main objective is to study the process of rehabilitation with main focus on early return to normal activities following the reconstructive procedures. SETTINGS AND DESIGN: Seventy three patients between the ages 17 to 65 years (mean age-36.43) with an injury period of up to 4 weeks were included in the study. For the 73 patients, 74 flaps were used. Patients with collagen disorder, liver disease. HIV positive patients and patients with history peripheral vascular diseases were excluded from the study. METHODS AND MATERIAL: This study was conducted in a tertiary teaching hospital over a period of two years from July 2012 to July 2014.Flap surgery was done in 73 patients with a total of 74 flaps. Defects of various regions of the lower extremity were selected for the study. A variety of reconstructive options are available for the lower extremity. This study includes patients from my private practice also. OBSERVATION AND RESULT: The flap surgery was successful in a variety of indications like trauma, infected chronic wounds, tumor excision and bone infections. There was a total failure of reverse sural artery flap in one patient. There was a partial necrosis of small area of the tip of the flaps in two patients with transposition fasciocutaneous flaps which healed by secondary intention in two weeks period. Venous congestion in two patients subsided on its own in 3 days. Three patients had minor infection problems which were treated with appropriate antibiotics. Two patients had partial skin loss in the donor areas which required secondary skin grafting procedures. CONCLUSION: Despite the fact free flaps are used more in the recent times, other flaps are still effective in the treatment of lower limb defects. Cross leg flap, a staged procedure was also used in our series for very large defects with good results. Muscle flaps and free flap were associated with fast recovery of patients and with minimal infection and non- union complications. Early skin cover gives the best results and the patients returned to normal activities earlier. Patients with fractures in whom flaps were done early along with bone graft procedures were ambulant early without problems of non-union. Patients who had muscle flaps for fractures and infective problems showed early wound healing. Most of the patients accepted the appearance of the flaps and a. very little percentage of patients returned back for secondary procedures of dog ear correction and thinning of the flaps.