Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons.Innovations in wound care,soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries.In this review,the principles of reconstruction of complex lower extremity traumatic wounds are outlined.These principles include appropriate initial evaluation of the patient and mangled extremity,as well as appropriate patient selection for limb salvage.The authors emphasize proper planning for reconstruction,timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option.The role of different reconstructive and wound care modalities is discussed,notably negative pressure wound therapy and dermal substitutes.The role of pedicled flaps and microvascular free-tissue transfer are discussed,as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium.Finally,the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds.Upon completion of this review,the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

Contemporary reconstruction after complex facial trauma

Complex facial trauma requires complex repair and solutions.This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result.Historically,the use of pedicled flaps,and then free tissue transfer,were the primary techniques utilized.Advancements in soft-tissue reconstruction,such as perforator flaps and pre-expanded and prefabricated flaps,allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage.The advent of contemporary technologies,such as virtual surgical planning,stereolithography and customized implants and plates,facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction.When surgical and technological techniques are combined in complementary multistage reconstructions,better reconstructive and aesthetic outcomes are achievable than ever before.In this review,the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience.Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed.A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result.We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.