Perineal and lower extremity reconstruction.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Perform a preoperative assessment of patients undergoing perineal and lower extremity reconstruction. 2. Describe the various tissue flaps used to perform these reconstructions and the advantages and disadvantages of each. 3. Provide appropriate postoperative care and interventions to maximize outcomes. BACKGROUND: The lower extremity and perineum provide the foundation for upright posture and ambulation. These areas are made up of intricate contours with variable skin types and must withstand the functional demands of organ orifice support and weight-bearing forces. Successful reconstruction calls for careful preoperative planning and consideration of the site-specific demands. METHODS: The authors reviewed literature regarding the most current treatment strategies for lower extremity and perineal reconstruction. RESULTS: Perineal reconstruction is typically related to genitourinary or digestive tract abnormalities, mainly malignancies. Local and regional flaps are the mainstay of therapy, depending on their availability and the need for adjuvant therapy. Postoperatively, pressure reduction and closed-suction drainage are of major consideration. The lower extremities are prone to trauma, and these wounds often involve underlying and exposed bony abnormalities, and this must be considered in operative planning. Significant defects may be reconstructed with local or regional flaps and free-tissue transfer. The location of the wound and extent of surrounding tissue compromise are of major concern when determining flap coverage. Postoperatively, transition to ambulation and weight-bearing status is paramount. CONCLUSIONS: Reconstruction of the lower extremity and perineum requires recognition of the high functional demands of these areas. Local and regional flaps and free tissue transfer allow reconstruction of complex wounds in these areas. Selecting the correct flap and navigating the postoperative recovery to arrive at functional restoration remain a significant challenge.

Simultaneous revascularization and coverage of a complex volar hand blast injury: case report using a contralateral radial forearm flow-through flap.

War wounds have created a unique reconstructive challenge for successful functional limb salvage. Various injury patterns related to improvised explosive devices (IEDs) occur and proper reconstruction goes a long way in reducing subsequent disfigurement and morbidity. One case in which a contralateral radial forearm flow-through flap is used for simultaneous revascularization and coverage of an IED hand blast injury is described. The advantages of this flap was its consistent arterial anatomy and long vascular pedicle. The thin skin paddle was used for soft tissue coverage of flexor tendon repair, median and ulnar nerve reconstruction, and metacarpal bone open reduction and internal fixation (ORIF). Recovery of motor function was satisfactory.