Non-microsurgical salvage of complex soft tissue defects in the lower extremity with transposition fasciocutaneous flaps

Background: Early soft tissue management is crucial in lower extremity defects, particularly those involving vital tissue exposure, bone integrity impairment or underlying instrumentation material. In the recent literature, free flaps and perforator flaps are considered as suitable options for this region. However early microsurgery planning may not be possible in every center due to the surgical experience, equipment or hospital and patient related factors. In such cases, transposition fasciocutaneous flaps emerge as a more accessible and efficient choice. Methods: All patients who underwent reconstruction with a random pattern transposition flap due to tissue defect in the lower extremity between 2019 and 2023 were retrospectively analyzed. Demographic characteristics, comorbidities, and defect mechanisms were recorded. Additionally, information regarding bone injuries, interventions performed, duration between injury and reconstruction, pre- and post-reconstruction cultures, and antibiotic treatments were documented. Post-reconstruction complications, ambulation period, and discharge time were also assessed. The limitations of microsurgery and reasons for flap planning were noted. Results: Twelve patients were included in this study. The mean age of the patients was 44 (20–67). The mechanism of defects were gunshot (6), fall (3), traffic accident (1), pressure ulcer (1), and tumor excision (1). In three patients (25%) who have previously undergone an operation for soft tissue defect, but there was exposed titanium implant or bone due to skin necrosis, a transposition flap was performed as a salvage procedure. In addition, 8 patients (73%) had multiple or comminuted bone fractures and 1 patient (8.3%) had a single bone fracture. While fixation was performed with titanium implants in 41.7% (5 patients) of the patients in the defect area, the fracture was stabilized with an external fixator in 2 patients and with a Kishner wire in 1 patient. Wound healing was observed good in 10 patients without other complex surgical intervention. Partial necrosis was observed in one patient due to infection. Partial dehiscence was observed in another patient with a pressure ulcer in the calcaneal region which was left to heal secondarily. Conclusions: Transposition fasciocutaneous flaps offers rapid planning process, easy disection and functionally and aesthetically benefits with proper planning. They should be considered as a simple option as salvage of complex soft tissue reconstruction. Level of evidence: Level IV, Therapeutic