Reconstruction of mutilating injuries of the lower extremity – Surgical decision-making for the plastic surgeon

High-energy traumas of the lower extremity caused by road accidents, gunshot injuries, or heavy construction equipment usually involve the bone and vascular structures as well as the soft tissues surrounding them. Reconstruction of these injuries may require teaming up with orthopedic and vascular surgeons to solve the dilemmas. Vascular evaluation and determination of the zone of injury is necessary to make the best possible reconstruction plan to achieve a functional and vascularized lower extremity. Although preoperative radiodiagnostic methods help in choosing the recipient vessels, flaps, and anastomotic technique, the ultimate decision is best made during surgery.