Reconstruction of Distal 1/3 of Lower Leg

Basic Principles

The distal 1/3 of the lower leg has a tendency for an open fracture or osteomyelitis to occur, and it can be difficult to obtain skin/muscle flap with vascular pedicle from the affected limb due to a lack of blood vessel length. Therefore, this is an area with good indication for use of free muscle and musculocutaneous flaps, but there is a higher possibility of thrombus occurring compared to the upper limb. To address this issue, anastomosis is conducted for the posterior tibial arterial system using end-to-side anastomosis as the method.

End-to-side anastomosis is also useful for retaining blood flow in the affected limb.

When performing free tissue transplant, posterior tibial artery end-to-side (side-to-side) anastomosis is the main method of anastomosis, and is conducted in the popliteal region or medial malleolus region.

The difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.