Microsurgery for lower extremity injuries.

SUMMARY: An entire generation of orthopaedic and plastic surgeons has been indelibly and perhaps overwhelmingly influenced by the introduction of microvascular technology to the fields of limb salvage and musculoskeletal reconstruction. Free-tissue transfer using microsurgical techniques has become a valuable method for the salvage of lower extremities after trauma. The goals of free flaps are both soft-tissue coverage and improvement of the functional outcome. The flap selection criteria for lower extremity reconstruction are based on the wound surface area, the type of tissue deficiency, length of the pedicle, volume of deficient tissue components and donor site morbidity. Composite flaps represent the state-of-the-art for reconstructive microsurgery, providing more than one function. Although many different treatment protocols have been proposed, they all highlight the importance of early tissue coverage with bone management performed in a later stage.