Avoiding complications in soft tissue coverage of lower extremity: an audit and review of literature

Objective: Th e objectives of this audit were to determine the frequency of complications occurring following coverage of soft tissue defects of lower limb and to analyze their causes. Material and methods: Th is was a prospective descriptive study of patients managed at Plastic and Hand Surgery Department of Liaquat National Hospital, Karachi from fi rst November 2007 to 30th of October 2008 and included all patients requiring soft tissue coverage of lower extremity except those who required soft tissue coverage of amputation stumps. Results: 107 patients were included in the study. Mean age was 31.6 years and there were 91 men (85%). Trauma was the most common cause (n=77) while leg was the most common site of defect. Most of the wounds were covered by skin graft s (65.4%) which all were split thickness. Fasciocutaneous local fl aps were employed in 22.4 % of cases followed by free fl aps (5.6%), perforator fl aps (3.7%), muscle fl aps (1.9%) and musculocutaneous fl aps (0.9%). Complications were observed in 35 patients (32.7%). Most common were partial graft loss (n=11, 10.3%), followed by partial fl ap loss (n=8, 7.8%) and total fl ap loss(5,4.7%). Donor site complications were observed in 4 patients (3.7%), 3 were partial loss of graft and one was delayed healing of donor site of graft . Only one mortality was encountered. Conclusion: Complications were higher for more complex procedure. Proper selection and good surgical technique yields good results in soft tissue reconstruction of lower limb. Suggestions were also given to avoid complications.