Immediate reconstruction of the lower extremity--an update.

The objective of emergency free-tissue transfer of complex lower extremity injuries is to provide primary coverage of the wound at the time of the first surgical procedure during the first 24 hours after the accident. This is achieved by meticulous debridement of soft tissues and bone in the zone of injury, by fracture stabilization by either external or internal fixation, by assuring good circulation with a direct artery repair or by the use of venous or arterial grafts, and by closure of the soft-tissue defect with a suitable free flap with microvascular anastomoses. Such a repair on an emergency basis requires cooperation between orthopedic and plastic surgeons and organization of a continuous microsurgical service. With these prerequisites fulfilled, emergency treatment of complex lower leg injuries gives predictably better results than delayed primary treatment in terms of lower free flap failure rate, lower infection rate, lower number of operations required to obtain the final result, shorter time of hospitalization, shorter time to bone healing and weightbearing, and lower cost of treatment. Emergency free-tissue transfer is not indicated in life-threatening situations.