Salvage of the massively traumatized lower extremity.

The prognosis of massive lower extremity injuries has been significantly altered by improved free flap success rates and a better appreciation for the need to perform an early aggressive debridement and reconstruction. Although some successes may be spectacular, many functional failures have been observed despite successful flap transfer. Reflections on the emerging principles and the lessons learned from the past decade of heroic efforts spent treating these injuries will reveal methods that may decrease the number of functional failures. These methods were observed by comparing the functional results of tibial reconstruction patients versus foot resurfacing procedures.