Combined use of pedicle and free-flap reconstruction in traumatic lower extremity wounds

World warfare necessitated the advancement of treatment of the traumatized lower extremity. Wound excision, immobilization and early secondary suture had been established by the end of World War I. Conservative debridement of skin with radical removal of devitalized subcutaneous tissue and muscle was expanded to include myoplasty as a biologic cover for exposed bone. The literature reports separate series including bone debridement and microvascular free-tissue transfer for soft-tissue reconstruction versus pedicle muscle flap reconstruction. Our series of three patients involved the combined use of pedicle flap and free-microvascular muscle transfer with skin grafting to achieve reconstruction of near total lower extremity skin avulsions and massive soft tissue loss. This proved to be a very effective method for achieving biologic coverage and function in these patients. This article reviews the history of reconstruction of the severely traumatized lower extremity and then compares our series with the accepted standard treatments found in the literature.