Page 8 - Read Online

Deldar et al. Plast Aesthet Res 2022;9:13 Plastic and
DOI: 10.20517/2347-9264.2021.100
Aesthetic Research

Review Open Access

Soft tissue coverage of lower extremity defects:
pearls and pitfalls in the chronic wound population

1,2
2
1
Romina Deldar , Chamilka Merle , Christopher E. Attinger , Karen K. Evans 1
1
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
2
Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA.
Correspondence to: Dr. Karen K. Evans, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University
Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA. E-mail: karen.k.evans@medstar.net,
prsgeorgetownresearch@gmail.com
How to cite this article: Deldar R, Merle C, Attinger CE, Evans KK. Soft tissue coverage of lower extremity defects: pearls and
pitfalls in the chronic wound population. Plast Aesthet Res 2022;9:13. https://dx.doi.org/10.20517/2347-9264.2021.100

Received: 7 Sep 2021 First Decision: 11 Oct 2021 Revised: 19 Oct 2021 Accepted: 29 Dec 2021 Published: 8 Feb 2022

Academic Editors: Matthew L Iorio, Marten Basta Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
The incidence of chronic lower extremity (LE) wounds continues to increase. Lower limb amputations are
associated with increased cardiovascular exertion, further decline in functional ability, and higher mortality rates.
As such, there has been a shift towards limb salvage modalities. These include local debridement with advanced
wound care, revascularization, bony reconstruction, and soft tissue reconstruction. Perioperative planning for soft
tissue reconstruction requires careful consideration of several factors, including patient comorbidities, wound size
and location, exposed underlying structures, and in the case of possible free flap, patency of donor and recipient
vessels. This article reviews the perioperative factors that should be considered in preparation for successful soft
tissue reconstruction of the LE.

Keywords: Free tissue transfer, chronic wounds, lower extremity, reconstruction

INTRODUCTION
Chronic wounds of the lower extremity (LE) can be defined as wounds that fail to heal within three months
of onset. LE wounds are a relatively common condition, affecting 1% of the adult population and 3.6% of
people older than age 65 . This incidence continues to rise as a result of an aging population and increased
[1-3]
atherosclerotic risk factors such as smoking, obesity, and diabetes mellitus (DM) . Diabetic foot ulcers
[1]

© The Author(s) 2022. 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.

www.parjournal.net