• Humans
• Free Tissue Flaps
• Male
• Retrospective Studies
• Female
• Adult
• Plastic Surgery Procedures/methods
• Leg Injuries/surgery
• Middle Aged
• Limb Salvage/methods
• Graft Survival/physiology
• Walking/physiology
• Lower Extremity/surgery
• Tissue and Organ Harvesting/methods
• Recovery of Function
• Treatment Outcome

• therapeutics
• wound closure techniques
• wounds and injuries

• Microsurgery
• Multidisciplinary approach
• Orthoplastic surgery
• Postoperative complications
• Vascularized grafts

• Humans
• Microsurgery/methods
• Plastic Surgery Procedures/methods
• Surgical Flaps

• Free tissue flaps
• Lower extremity reconstruction
• Omentum

• Distal transverse digital artery
• Dynamic digital thermography
• Hand injury
• Perforating flaps

• Humans
• Adult
• Soft Tissue Injuries/surgery
• Treatment Outcome
• Surgical Flaps/blood supply
• Surgical Flaps/surgery
• Plastic Surgery Procedures
• Wounds, Gunshot/surgery
• Arteries/surgery

• Humans
• Retrospective Studies
• Surgical Flaps
• Lower Extremity/surgery
• Lymphedema/surgery
• Muscles
• Free Tissue Flaps

Medical infrared thermography (IRT) was used as a complementary means for the clinical evaluation of musculoskeletal trauma and progression of chronic tibial osteomyelitis.

Twenty-two adult patients with a medical diagnosis of chronic tibial osteomyelitis were followed up by IRT performed along with standard radiography. Thermal data of the affected limb were compared with those of the healthy contralateral limb based on the thermal profile of the lower limbs as per the medical thermography guideline (32 °C). Data were acquired in the following regions of the lower limb: proximal tibia, diaphysis, and distal tibia, using a FLIR infrared camera, and data were processed using MATLAB®.

For patients with active infections, an increase in the average temperature of the affected limb above + 1.0 °C was observed when compared with the temperature of the contralateral. The wound region of the patients showed an increased temperature (32.3 °C) compared with the temperature of the contralateral (31.4 °C). In contrast, in latent infections, the thermal differences were small, generally below 0.3 °C, and thus were within the threshold of normality. In contrast, in areas diagnosed with reduced blood supply, the affected limb showed an average temperature up to − 5.7 °C below normal. Additionally, the initial temperature range (26.5 to 34.5 °C) decreased during the treatment to 29.8 to 34.1 °C, indicating a convergence toward normality.

IRT has significant potential as a complementary imaging modality in the follow-up of patients with bone lesions with a diagnosis of osteomyelitis as it does not use ionizing radiation, thus allowing repetitive use as desired. Thermal images show important physiological information related to vascularization necessary for bone repair, as well as provide a good indication of the boundary of the infected area, adjacent to the trauma, which is useful for positioning the radiography equipment. However, it should be noted that IRT cannot replace other medical imaging techniques, as it provides information about the skin and cannot directly evaluate the interior of the body.

• Lower limb reconstruction
• Perforator artery flap
• Peroneal artery
• Posterior tibial artery
• Propeller flap
• Resident

• Extremity
• tissue expansion
• wound reconstruction

• Bone fracture
• Lower limb
• Propeller perforator flap
• Soft tissue defect

• Free flaps
• Local flaps
• Lower limb
• Open fractures

• Fracture Fixation, Intramedullary
• Fracture Healing
• Fractures, Open/surgery
• Humans
• Retrospective Studies
• Tibial Fractures/diagnostic imaging
• Tibial Fractures/surgery
• Treatment Outcome

• Extremities
• Flap
• Limb salvage surgery
• Microsurgery
• Sarcoma
• Trunk

• Adipofascial flap
• Distal one - third leg defect
• Lower limb reconstruction
• Reverse sural flap
• Two-staged fasciocutaneous reverse sural flap

• Amputation
• Foot salvage
• Free muscle flaps
• Replantation

• Lower limb
• Open fracture
• Orthoplastics
• Paediatric, elderly

Management of composite defects of leg following trauma requires a planned ortho-plastic approach right from the outset. Timely, planned intervention results in reduced amputation rates and improved limb salvage and function. Right from the time of presentation of the patient to the emergency with such injury, the process of decision making in terms of salvage or amputation, local flap cover/free flap cover, bone reconstruction first or soft tissue or both combined, come into play. Guidelines on management are unclear for such defects, a literature search yielding various methods being used by different authors.

This article is a review of current literature on management of composite leg defects.

A summary of the literature search in terms of various management options given by various authors including the rationale, advantages and disadvantages of each strategy has been provided in this article. The management protocol and method followed by the author in his institute for management of such composite defects have been described in detail. The article seeks to provide readers with an understanding of the management strategies so that appropriate method could be chosen to provide best result.

• Ilizarov
• bone defect
• composite defect
• distraction
• free fibula
• free flap
• leg trauma
• lower limb trauma

• Cross leg flaps
• Foot
• Local flaps
• Lower third of leg

• Chimeric fibula flap
• Composite perigenual defects (CPGDs)
• Pedicled propelled fibula osteomyocutaneous flap

• Extremities
• Flap
• Limb salvage surgery
• Microsurgery
• Sarcoma
• Trunk

• Delay amputation
• Injury severity score
• Limb salvage
• MESS
• Mangled extremity severity score

Soft-tissue defects of the distal lower extremity and foot present significant challenges to the reconstructive surgeon. The reverse superficial sural artery flap (RSSAF) is a popular option for many of these difficult wounds. Our initial experience with this flap at multiple institutions resulted in a 50% failure rate, mostly because of critical venous congestion. To overcome this, we have modified our operative technique, which has produced a more reliable flap.

All patients reconstructed with an RSSAF between May 2002 and September 2013 were retrospectively reviewed. In response to a high rate of venous congestion in an early group of patients, we adopted a uniform change in operative technique for a late group of patients. A key modification was an increase in pedicle width to at least 4 cm. Outcomes of interest included postoperative complications and limb salvage rate.

Twenty-seven patients were reconstructed with an RSSAF (n = 12 for early group, n = 15 for late group). Salvage rate in the early group was 50% compared with 93% in the late group (P = 0.02). Postoperative complications (75% vs. 67%, P = 0.70) were similar between groups. Venous congestion that required leech therapy was 42% in the early group (n = 5) and 0% in the late group (P = 0.01).

Venous congestion greatly impairs the survival of the RSSAF. A pedicle width of at least 4 cm is recommended to maintain venous drainage and preserve flap viability.

Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

• Fasciocutaneous flap
• Distally based flap
• Foot and ankle
• Perforator flap
• Neurocutaneous flap
• Sural flap
• Propeller flap

• ALT fasciocutaneous flap
• bone reconstructive surgery
• bone scintigraphy
• vacuum-assisted closure

The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

• Limb salvage
• foot ulcers
• limb trauma
• lower limb reconstruction

• Advanced dressings; Conservative treatment; Degloving injuries; Dermal substitute; Negative pressure therapy

• Adult
• Fasciitis, Necrotizing/diagnosis
• Fasciitis, Necrotizing/etiology
• Fasciitis, Necrotizing/surgery
• Follow-Up Studies
• Graft Survival
• Humans
• Leg Injuries/complications
• Leg Injuries/diagnosis
• Leg Injuries/surgery
• Male
• Quadriceps Muscle/transplantation
• Plastic Surgery Procedures/methods
• Skin Transplantation/methods
• Surgical Flaps
• Thigh/surgery