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Lower Limb Reconstruction After Open Fractures

Fractures (broken bones) in the leg can take a long time to heal. If the skin over the bone that is broken is also damaged, the risk of infection is much higher. This can significantly affect healing of the leg. When this happens, closure of the wound becomes extremely important. How this happens varies considerably depending on the extent of damage to the bone and overlying skin and soft tissues. It also depends on which part of the leg has been injured. In general, there is less cope for stitching the skin together at the lower end of the leg towards the ankle and foot.

After cleaning the wound and fixing the fracture with metal plates or rods or an external frame if needed, priority turns to closing the wound. Several techniques can be used. Where possible to simply stitch the wound together, this is done. Sometimes due to the severity of tissue damage or swelling, it is not possible to do this. In those cases, reconstruction of the missing tissue can be done by using a skin graft or skin and muscle flaps. Tissue is moved from another part of the body to replace that missing in the injured part of the leg. If it is possible to move tissue or muscle from beside the area to cover the fractured bone, then this is the first choice. However, it may be necessary to take tissue (skin or muscle) from another part of the body such as the thigh or back and use this to cover the wound. It is then necessary to reattach the blood vessels in this transfered tissue to blood vessels in the leg to keep it alive. While quite a long surgery, this is a very effective way to heal the wound and reduce the risk of infection at the fracture site.