Role of microsurgery in lower extremity reconstruction

Developments in reconstructive microsurgery have heralded a new phase of limb-saving procedures. Although pedicled local fasciocutaneous or muscle flaps continue their useful role, microsurgical free tissue transfer is usually required for larger defects and also for areas without locoregional options. As this treatment modality has become more established, innovation and technical refinements have resulted in an evolution of flap surgery, including perforator and free-style free flaps, that has been applied to lower limb surgery. Effective outcome measures, bioelectronic prostheses, and composite tissue allotransplantation are the three major trends leading into a new era of lower limb reconstruction. This article outlines the role of microsurgical free tissue transfer for lower limb salvage and reconstruction.