الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Reconstruction of soft tissue defects of the lower leg starts with debridement of all necrotic and devitalized tissues and it may be repeatedly done in heavily contaminated wounds. There are variable reconstruction techniques starting from skin grafting to free flaps.
Skin grafts can be used to cover defects over muscles or fascia but not over bones or tendons devoid of periosteum or paratenon, respectively.
Local random pattern rotational flaps are also available and can be used for small defects whenever good and healthy nearby tissues are available.
Fasciocutaneous flaps are widely used flaps for coverage of variable sized defects. It has the advantages of covering large defects, preservation of the main vascular access of the limb, less bulky than muscle flaps, less donor site morbidity, better cosmetically than skin grafts and does not need highly trained surgeons like free flaps.
Muscle and musculocutaneous flaps are another option for coverage of defects. The limiting factor for their use is that most of reliable flaps can be used to cover upper two thirds of the leg and the available flaps for the lower third like soleus muscle and local muscle flaps have a limited values.
The emergence of microvascular techniques paralleled the development of the operating microscope, micro instruments and sutures so the ability to transplant a flap to a distant site eliminated the necessity to select a flap with an arc of rotation that reaches the defect. This allows the transfer of composite tissue based on flap suitability for defect coverage rather than proximity to the defect.
This study included 20 patients with post traumatic lower third leg soft tissue defects from department of plastic surgery at Al Menoufia University Hospital and Al Nile Health Insurance Hospital, in Qaliubya, in the period between May 2016 and July 2017. Patients’ age ranged from 16 to 60 years old. 18 cases were males and 2 cases were females. 18 cases were presented after road traffic accidents and 2 cases were presented with post burn unstable scar. 12 cases were associated with skeletal fractures, while 8 were not. 12 cases were associated with comorbidities, while 8 cases were free.
In total, 2 split thickness skin grafts (10%), 10 local fasciocutaneous flaps (50%), 4 local muscle flaps (20%), and 4 free flaps (20%) were used for reconstruction with (100%) healing rate in the split thickness skin grafts, muscle flaps, and free flaps, while the complication rate in the fasciocutaneous flaps were (20%).
In the entire patients, 4 patients (20%) developed a postoperative complication, which consisted of development a partial flap necrosis, after which the necrotic part of the flap was debrided and skin grafted in 1 case, left to heal by secondary intention in 1 case, readvancement of the flap in 1 case and a free rectus abdominis muscle flap was used in 1 case.
The mean length of hospital stay in days was 9.5 for the skin graft group, 18.6 for the fasciocutaneous flap group, 14.25 for the muscle flap group, and 17.5 for the free flap group. The mean delay time in days between the trauma and the operation was 35 for the skin graft group, 8 for the fasciocutaneous flap group, 19.75 for the muscle flap group, and 115 for the free flap group. The mean operative time in minutes was 57 for the skin graft group, 79.5 for the fasciocutaneous flap group, 93.75 for the muscle flap group, and 312 for the free flap group.