title: Changes in donor site selection in lower limb free flap reconstructions.
abstract: Since 1973 we have performed over 1,000 free flap reconstructions mainly in head and neck, breast, and upper and lower limb surgery. In lower leg reconstructions, changing indications for flap selection were not only correlated to new anatomical developments, but mainly due to a better understanding of adaptability of known muscle or fascial free flaps. Reducing donor site morbidity and planning for saving donor sites for future reconstructions are important. Morbidity is reduced by selection of free flaps ideally adjusted to the shape of the defect. Innervated free flaps or functional muscle transplants are rarely indicated in the lower leg. In the early years of microsurgical free flaps, soft tissue reconstruction or bone coverage was the primary indication. Later improving the vascularity of the wound bed by free flap cover increased the indication to chronic infected leg ulcers, osteomyelitis, diabetes, or artheriosclerotic wound defects or pressure sores due to lack of sensibility. Reconstruction of the foot and restoring its weight-bearing capacity is one of the more challenging applications of free flap cover.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Leuven University Hospitals, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Boeckx
authors.forename: B
authors.initials: B
authors.lastname: van den Hof
authors.forename: C
authors.initials: C
authors.lastname: van Holder
authors.forename: P
authors.initials: P
authors.lastname: Blondeel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000672:Amputation Stumps / Q000601:surgery; D000842:Ankle / Q000601:surgery; D002056:Burns / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005528:Foot / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D005627:Frostbite / Q000601:surgery; D006365:Heel / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007717:Knee / Q000601:surgery; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000601:surgery; D007871:Leg Ulcer / Q000601:surgery; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D010019:Osteomyelitis / Q000601:surgery; D003668:Pressure Ulcer / Q000601:surgery; D011542:Pseudarthrosis / Q000601:surgery; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery; D013977:Tibia / Q000601:surgery; D014884:Waterhouse-Friderichsen Syndrome / Q000601:surgery