Microvascular free tissue transfer in reconstruction of the lower limb.
A meticulous surgical technique is crucial to ensure an optimal oncological and functional outcome for the patient. Successful limb-sparing surgery consists of three interdependent stages performed in sequence as follows: tumour resection with appropriate oncological margins, reconstruction and stabilization of the involved bone and joints, and restoration of soft tissue envelope and restoration of function. After tumour resection of the lower extremity complex, defects are anticipated and multiple variables must be considered for soft tissue reconstruction. A large number of details must be taken into consideration when planning a reconstruction, especially after oncological surgery. One must consider the timing of reconstruction, size and location of the defect, involvement of neurovascular structures, and exposure or resection of bone, tendons, and nerves. Donor site morbidity, disease prognosis, and the patient’s previous level of function and expectations of restored function must be evaluated as well. Reconstructive options for the lower leg with regard to local flaps are limited particularly for the lower third can be challenging, thus free flaps are often required.