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Evans et al. Plast Aesthet Res 2022;9:34 Plastic and
DOI: 10.20517/2347-9264.2021.134
Aesthetic Research

Review Open Access

The evolution of lower extremity reconstruction

Brogan G. A. Evans, David L. Colen
Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA.
Correspondence to: Dr. David L. Colen, Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of
Medicine, Colen, 330 Cedar St, BB330, New Haven, CT 06510, USA. E-mail: david.colen@yale.edu

How to cite this article: Evans BGA, Colen DL. The evolution of lower extremity reconstruction. Plast Aesthet Res 2022;9:34.
https://dx.doi.org/10.20517/2347-9264.2021.134

Received: 19 Dec 2021 First Decision: 10 Feb 2022 Revised: 16 Mar 2022 Accepted: 24 Mar 2022 Published: 6 May 2022

Academic Editor: Matthew L Iorio Copy Editor: Tiantian Shi Production Editor: Tiantian Shi

Abstract
Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication
over the past century. Early advances in treating traumatic lower extremity injuries focused on primary amputation
to avoid the high mortality of infection. The introduction of antibiotics improved surgical debridement and local
reconstructive options, enhancing the viability of lower extremities with simple and proximal defects. With the
advent of microvascular surgery, free tissue transfer techniques provided a means to reconstruct more distal and
complex problems. As these surgical techniques have continued to evolve, so too have indications for
reconstruction, patient management and post-operative care-now with a greater emphasis on patient quality of life
and limb function. The purpose of this article is to outline the evolution of lower extremity reconstruction, and how
the standard of practice has changed over time.

Keywords: Lower extremity, lower extremity reconstruction, limb salvage, free flap, perforator flap, vascularized
bone flap, orthoplastic surgery

INTRODUCTION
Traumatic injuries of the lower extremity are complex in nature. Mechanism of injury often predisposes
these wounds to contamination, with high rates of infection when not appropriately debrided . Prior to
[1-7]
the industrial revolution, injuries of the lower extremity were largely sustained on the battlefield secondary
[8,9]
ballistic or blunt force trauma . High mortality rates from infection made primary amputation the
standard of care in treating lower extremity injuries [9,10] . The invention and increasing accessibility of

© 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.

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