Plastic Surgery Essentials for Students-Chapter 16: Lower Extremity

Chapter 16: Lower Extremity

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Chapter 16 of the document focuses on the lower extremity and the various wound and trauma issues that plastic and reconstructive surgeons often encounter. It discusses chronic wounds, emphasizing the importance of accurate diagnosis and involves different types of ulcers such as venous stasis, ischemic, diabetic, and pyoderma gangrenosum.<br /><br />For <strong>venous stasis ulcers</strong>, caused by venous hypertension, treatments focus on controlling venous pressure with methods like bed rest, elevation, or "Unna boots," and may include surgical excision. <strong>Ischemic ulcers</strong> result from arterial occlusion, often require revascularization and, if necessary, skin grafts or flap closure. <strong>Diabetic ulcers</strong> are associated with decreased sensation and need careful management, including debridement and infection control, avoiding premature amputation. <strong>Pyoderma gangrenosum</strong> ulcers are treated with a combination of local wound care and medication such as anti-inflammatory drugs, with surgery often contraindicated.<br /><br />The chapter also addresses <strong>acute lower extremity trauma</strong> needing a collaborative approach among specialists for limb salvage. Initial trauma management includes surgical debridement and addressing compartment syndrome through fasciotomy. Fractures are classified by the Gustilo system, with Type III injuries often requiring plastic surgical intervention.<br /><br /><strong>Non-surgical care</strong> includes using wound vac systems that apply negative pressure to assist with healing and may reduce the need for flaps. <strong>Surgical care</strong> comprises indications for limb salvage versus amputation and assessing the need for graft or flap coverage, highlighting anterior, middle, and lower third leg options for coverage choices like the gastrocnemius or soleus flaps.<br /><br />The chapter also discusses bony gaps filling and post-operative procedures such as elevation and protocols for getting flaps accustomed to dependent positions. It includes references to classic studies and criteria utilized in surgical decision-making.

Keywords

lower extremity

chronic wounds

venous stasis ulcers

ischemic ulcers

diabetic ulcers

pyoderma gangrenosum

acute trauma

limb salvage

wound vac systems

flap coverage