The major defects of lower limb of different magnitude are frequently encountered, and majority of them require reconstruction. Such wounds fall into two categories, acute deep wounds and those which have not healed within 6 weeks, i.e., chronic wounds. The common causes are trauma, infection, postexcisional defect, venous ulcer, trophic ulcer, etc. For the consideration of resurfacing, they are divided into those requiring split skin grafts (SSG) and the others which need a flap. Before coverage, an acute wound needs to be free of devitalized tissue and foreign bodies through adequate surgical debridement and cleaning with normal saline under proper light in the operation theater. Similarly a chronic defect should be free of infection which can be achieved by debridement and regular dressing. The wound swab is sent for culture and sensitivity, and accordingly a suitable antibiotic is administered. The defect is then assessed in terms of size, contour, and exposed vital structures. It is also necessary to evaluate whether the defect needs only SSG, flap, or combination of them. Accordingly the decision is made regarding the type of reconstruction. The aim is to have functional and aesthetic outcome preferably in a single stage with minimal donor site morbidity. If it is noncontoured surface defect, split skin graft is indicated. If the underlying vital structures are exposed, e.g., bone and joints, tendons, neurovascular bundle, exposed hardware following bony fixation, etc., a flap cover is needed. Sometimes part of the wound requires a flap and the rest can be managed by SSG (Fig. 1).
Muscle Flap Deep Fascia Fasciocutaneous Flap Peroneal Artery Split Skin Graft
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