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Yu et al. Plast Aesthet Res 2022;9:37 Plastic and
DOI: 10.20517/2347-9264.2021.124
Aesthetic Research

Review Open Access

Current concepts in microsurgical soft tissue
reconstruction of lower extremity trauma in a single-

vessel extremity

Jenny L. Yu, Philip D. Tolley, Cameron Kneib, Erin A. Miller, Christopher S. Crowe
Division of Plastic Surgery, University of Washington, Seattle, WA 98104, United States.
Correspondence to: Dr. Jenny L. Yu, Division of Plastic Surgery, University of Washington, 325 9th Ave. Mailstop 359796,
Seattle, WA 98104, United States. E-mail: yujenny@uw.edu

How to cite this article: Yu JL, Tolley PD, Kneib C, Miller EA, Crowe CS. Current concepts in microsurgical soft tissue
reconstruction of lower extremity trauma in a single-vessel extremity. Plast Aesthet Res 2022;9:37.
https://dx.doi.org/10.20517/2347-9264.2021.124

Received: 20 Nov 2021 First Decision: 17 Feb 2022 Revised: 22 Feb 2022 Accepted: 28 Mar 2022 Published: 17 May 2022

Academic Editor: Matthew L Iorio Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Advancements in microsurgical techniques have allowed for the salvage of extremities that would otherwise be
amputated. Despite these improvements, mangling injuries of the lower extremity with concomitant open fracture
continue to present a challenge for reconstructive surgeons. These injuries are further complicated by
circumstances in which a single vessel is perfusing the foot after trauma (Gustilo 3C injuries). Although the foot
may remain perfused in this instance, free flap coverage of open fractures with concomitant vascular injury
requires careful planning to maintain a viable foot. The surgeon must adapt surgical plans based on both
preoperative and intraoperative findings. In this review, we discuss current concepts and reconstructive techniques
for performing free flap reconstruction in single-vessel lower extremities.

Keywords: Lower extremity, reconstruction, microsurgery

INTRODUCTION
Soft tissue reconstruction of lower extremity trauma comprises a wide range of management strategies that
depend on the condition and presence of critical structures within the wound. Gustilo III injuries requiring
free flap coverage represent the highest tier of the reconstructive ladder, and deserve careful consideration

© 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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