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Zhang et al. Plast Aesthet Res 2019;6:30 Plastic and
DOI: 10.20517/2347-9264.2019.040 Aesthetic Research

Review Open Access

Progressive trends in timing and imaging of lower
extremity reconstruction

Andrew Y. Zhang , David Cholok , Gordon K. Lee 2
2,#
1,#
1 Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
2 Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, USA.
# Authors contributed equally.
Correspondence to: Dr. Gordon K. Lee, Division of Plastic and Reconstructive Surgery, Stanford University, 770 Welch Road,
Suite 400, Stanford, CA 94304, USA. E-mail: glee@stanford.edu
How to cite this article: Zhang AY, Cholok D, Lee GK. Progressive trends in timing and imaging of lower extremity reconstruction.
Plast Aesthet Res 2019;6:30. http://dx.doi.org/10.20517/2347-9264.2019.040
Received: 15 Oct 2019 First Decision: 15 Nov 2019 Revised: 19 Nov 2019 Accepted: 9 Dec 2019 Published: 17 Dec 2019

Science Editor: Matthew L. Iorio Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

The salvage of mangled lower-extremities after severe injury remains a daunting operative dilemma, but one that
continues to evolve with advances in microsurgical and orthopedic techniques. Specifically, trends in clinical practice
including the decision to salvage and timing of soft-tissue coverage are changing in concordance with improvements
in wound care, flap selection for soft-tissue provision, and preoperative imaging. Due to these improvements, more
complex wounds are increasingly eligible for reconstruction. It remains unclear, however, whether success in limb
salvage confers improved functional patient outcomes. We present a review of the literature tracing recent advances
in the salvage of mangled extremities following traumatic injury, with a focus on practice trends regarding timing of
reconstruction, operative approaches, and preoperative imaging.

Keywords: Lower extremity, reconstruction, propeller flaps, amputation, microsurgery, trauma

INTRODUCTION
Complex high-energy trauma to the lower extremity often entails significant and devastating morbidity for
patients. Lower extremity injury accounts for greater than 250,000 hospital admissions each year in the US;
[1]
more than half involve open long-bone fractures, crush, or major soft-tissue injury . Return of function
can be an arduous process requiring multidisciplinary care and ongoing therapy for months to years.
Plastic surgeons involved in the care of these patients should be well versed in the unique demands required

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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