Traumatologia dei tessuti molli nell'arto inferiore: problematiche cliniche e possibilità terapeutiche

Four main anatomical and surgical districts may be distinguished in the lower limb: thigh, knee district, lower leg and foot. In the thigh many serious cases can be healed by grafts (after vacuum and/or hyperbaric therapy). In the knee the skin is the only soft tissue on tendons, bones ligaments and joints and also prothesis in same cases. Medial or lateral fascio cutaneous flaps are the first choice reconstrucion methods. In osteomyelitis the reconstruction can be succesfully obtained by a gastrocnemious muscle flap. Tissue expanders can be usefully used for scar tissue contracture. In the lower leg, where tendons and bones exposure is frequent we use reverse loco regional flaps (sural flaps, Gumener's fascio subcutaneous flap) and free flaps (large dorsal flaps). The foot is the most difficult district from a reconstructive point of view. Medial plantar flaps with reverse flaps (sural and fascio subcutaneous flaps) represent the first choice surgical methods in the heel reconstruction. During the frequent crushing traumas of the forefoot, digital damage may impose amputation. Local flaps (reverse fascio subcutaneous flaps and V-Y flaps) may be insufficient for the major loss of substance. The utilization of micro surgical flaps often represents the only possibile surgical option.