INTRODUCTION: Lower extremity reconstructions may be pursued by adhering to established algorithms primarily based on the area of injury and the extent of missing tissue and wound. Certain flaps--either local or free--have been relied on as workhorse flaps for soft-tissue reconstruction of the lower extremity. However, when these flaps are unavailable or contraindicated, alternative options can be considered for reconstruction of relatively small wounds in the lower extremity.
METHODS: We report 2 cases of complex lower extremity wounds that were the result of complications from orthopedic procedures after traumatic injuries. In case 1, an exposed Achilles tendon (7×3 cm) after wound infection and breakdown after orthopedic fixation was performed using a distally based peroneal brevis muscle flap with split thickness skin grafting. The same patient also had a previous free anterolateral thigh flap for the coverage of his medial tibial wound in the distal third of the leg with success. In case 2, a middle lateral leg wound (5×3 cm) with exposed tibia as a result of hematoma and wound breakdown after orthopedic debridement was reconstructed with a distally based tibialis anterior muscle flap with split thickness skin grafting.
RESULTS: Full soft tissue coverage of the defects was achieved using these distally based local muscle flaps. There was complete healing of each complex wound in the lower extremity without complications, thus a microvascular free flap reconstruction for those patients was avoided. Aesthetic appearance of the reconstructions was closely matched to the native skin. Functional status was acceptable over long-term follow-up in both patients.
CONCLUSIONS: For complex lower extremity wounds, less commonly used local muscle flaps that are distally based may successfully reconstruct certain relatively small defects in the lower extremity. Knowledge of these flaps and illustration of their success allow the reconstructive surgeon to confidently add them to the reconstructive armamentarium.
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