Approach to Complex Lower Extremity Reconstruction

David Cholok*, Ean Saberski, David W. Lowenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Composite injuries to the lower extremity from etiologies including trauma and infection present a complex dilemma for the reconstructive surgeon, and require multidisciplinary collaboration amongst plastic, vascular, and orthopaedic surgical specialties. Here we present our algorithm for lower-extremity reconstructive management, refined over the last decades to provide an optimized outcome for our patients. Reconstruction is predicated on the establishment of a clean and living wound, where quality of the wound-bed is prioritized over timing to soft-tissue coverage. Once established, soft-tissues and fractures are provisionally stabilized; our preference for definitive coverage is for microvascular free-tissue, due to the paucity of healthy soft-tissue available at the injury, and ability to avoid the zone of injury for microvascular anastomosis. Finally, definitive bony reconstruction is dictated by the length and location of long-bone defect, with a preference to utilize bone transport for defects longer than 5 cm.

Original languageEnglish
Pages (from-to)233-242
Number of pages10
JournalSeminars in Plastic Surgery
Issue number4
StatePublished - Nov 2022
Externally publishedYes


  • fractures
  • lower extremity
  • negative pressure wound therapy


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