Significant advancements have been made in the management of lower extremity reconstruction since Dr. Taylor's seminal case in 1973. Improvements in our understanding of vascular anatomy and evolution of microsurgical techniques have allowed for an ever-increasing array of free tissue transfer options for lower extremity reconstruction. The resulting expertise has engendered a paradigm shift toward the reconstructive elevator approach, with increased emphasis on cosmetic results. In the primary setting, aesthetic considerations play an important role in precoverage wound preparation, flap selection, and harvest technique, with the goal of achieving excellent like-with-like reconstruction at the time of initial surgery. Flap selection should be made to best match the three-dimensional architecture of the wound, and take into account the defect thickness, flap thickness, flap composition, and pedicle length. Primary flap thinning and harvest in the superficial fascial plane has been shown to be an effective modality to address excess adiposity and improve contour. Despite these efforts, secondary procedures are often required to optimize the limb's final appearance and functional outcomes, particularly in the foot and ankle region. These include debulking, liposuction, and staged excisions. As the field of limb salvage keeps evolving, aesthetics will continue to play an important role in extremity reconstruction planning and execution.
Faculty
Alexander Govshievich, MD; Andrew Bauder, MD; Stephen J. Kovach, MD; L. Scott Levin, MD
Plastic and Reconstruction Surgery
Editors: Editor-in-Chief: Kevin Chung,
MD
Co-Editor: Amy Colwell, MD
Section Editors: John YS Kim, MD
Intended Audience
This educational activity is intended for all CME-related persons including plastic surgery practitioners, residents, and other healthcare professionals.
Learning Objectives
After viewing this course, the participant should be able to:
- Have an in-depth understanding of the functional and aesthetic requirements of lower extremity reconstruction.
- Describe the considerations for achieving an optimal aesthetic outcome in the primary reconstruction settings.
- Describe modalities of secondary flap revision for achieving an optimal aesthetic outcome.
AccreditationThe American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Designation
The ASPS designates this enduring material for a maximum of1.0AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure Policy
The American Society of Plastic Surgeons (ASPS) requires all faculty, authors, planners, reviewers, managers, staff and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. The ASPS also requires faculty/authors to disclose when off-label/unapproved uses of a product are discussed in a CME activity or included in related materials.
Disclaimer: All relevant financial relationships for planners, faculty, and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.The following planners/faculty members/reviewers have no relevant financial relationships or affiliations to disclose:
AMA PRA Category 1 CreditTM:1.0
Patient Safety Credit: 0.5
Media:Journal Article, video
Release Date: 4/01/2023
Expiration Date:4/01/2026
Estimated time to complete this course:1 hour
*Course access ends on course expiration date
Directly provided by the American Society of Plastic Surgeons (ASPS)
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