PROCEDURES

LOWER LIMB

INDICATIONS

The lower limb has two main functions

1. Static support while standing

2. Ambulation

The goals of lower limb reconstruction are to maintain those functions following trauma, medical illness, or as a complication of surgery. The best candidates for lower limb reconstruction are, therefore, individuals with open wounds or defects in a lower limb as a result of trauma, tumour, or congenital abnormalities.

Common conditions in which lower limb reconstruction is considered

• Extensive injury (bone and soft tissue) due to trauma

• Osteomyelitis or bone infection

• Chronic wounds due to vascular disease or diabetes

• Exposed prosthetic joints after hip or knee replacement

• Exposed grafts after vascular surgery to improve blood flow in the lower limb

TREATMENT OPTIONS

Lower leg wounds are treated depending on their extent, location on the lower limb and whether infection is present or not. Specialised dressings are used to treat superficial wounds that do not involve bone. Another option, especially when a cavity needs to be filled, is negative-pressure wound therapy (vac therapy) where a dressing is connected to a suction machine to improve blood flow and facilitate healing. Dr Sofianos involves specialised tissue viability nurses (TVN) in these treatments. 

When there is exposure of underlying bone, closure of the wound usually requires movement of tissue into the area. Depending on the location of the wound, local or adjacent tissue may be used, but in the majority of cases, tissue from another part of the body (usually the thigh) needs to be imported and reconnected to blood vessels. Dr Sofianos utilises specialised microvascular techniques gained during training, and his fellowship, to treat these wounds.

In certain cases, where wound closure fails, infection is too severe or the blood flow to the lower limb is compromised or cannot be restored, amputation is considered.

RECOVERY

Recovery is usually prolonged and involves intense rehabilitation and physical therapy to strengthen muscles, improve stability, and address stiffness due to inactivity. The recovery period is heavily dependent on the wound treated and the actual treatment option employed.

 

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