Surgical treatment of wounds of the lower leg and foot with loss of substance

In the surgical treatment of wounds of the distal regions of the leg with loss of substance, particular anatomical conditions and the frequent coexistence of previous diseases or of diseases connected to the trauma make it hard to choose the most appropriate surgical strategy and require a multidisciplinary approach. Timing and treatment modalities must be decided by different operators in order to ensure a lower risk of post-surgical complications and disabling outcomes. The need for plastic and reconstructive treatment is growing as a result both of the improvement in reconstructive techniques and of the increased incidence of major injuries. The authors report their own experience with the treatment of 21 patients (14 males and 7 females). Partial-thickness skin grafts were performed in 11 cases (7 lower-third leg injuries and 4 foot wounds). Fasciocutaneous flaps were used in 8 patients (5 lower-third leg injuries and 3 wounds to the distal third of the foot), while microsurgical flaps were used in 2 cases of exposed injuries to the foot. The authors report the results obtained and the healing times in relation to the severity of the injuries and the complications observed. Patient treatment modalities are discussed and the results analysed.