Segmental bone defects of the lower leg. Valence of soft tissue reconstruction

Segmental bone defects mostly result from high energy accidents and are characterized by combined injuries in many types of tissue. The most important requirement for success of bony reconstruction and salvage of the extremity is a sufficient soft tissue covering with vital, well-perfused and infection-free tissue. After radical sequential debridement all techniques in the plastic surgery reconstruction repertoire can be used. Free flaps in particular fulfil all requirements for such compound defects. In cases of segmental defects > 6 cm a "one-stage reconstruction" with free vascularized bone transfer is the current state of the art. If an infection is additionally present, a well-perfused muscle flap, such as a musculocutaneous latissimus dorsi flap or gracilis flap should be selected. The optimal time point of reconstruction is early secondary defect covering within the first 24-72 h after trauma. An acute defect covering with emergency freeflaps is rarely indicated. All operative procedures should be performed in an interdisciplinary cooperation between trauma and plastic surgeons. However, despite the high success rate of extremity salvage due to modern combined treatment techniques, a permanent restriction of function and reduction in quality of life should be considered and integrated into treatment concepts.