Reconstructive strategies with flaps in traumatic injuries of the lower limbs: a comparative analysis of risks and benefits

Abstract

Introduction: Reconstruction of traumatized limbs involves complex challenges in injuries affecting vascular, bone and soft tissue structures. Free flaps are preferred in severe cases due to their ability to ensure functional and stable coverage through vascularized transplantation. The choice of flap is based on the location, size of the defect and availability of tissue, with options such as fasciocutaneous and helix flaps standing out. In exposed fractures type IIIB and IIIC according to Gustilo Anderson, the use of flaps is crucial to manage vascular compromise and reduce infections, optimizing the function and aesthetics of the limb. Objective: To evaluate the risks and benefits of flap reconstruction in the treatment of traumatic injuries of the lower limbs, through a comparative analysis that considers the severity of the injury and the intrinsic factors of each patient, in order to determine the viability of this technique. Materials and methods: This is a literature review on reconstructive strategies with flaps in traumatic injuries of the lower limbs, based on recent studies (2019-2024) with a high level of evidence. Six articles were analyzed after an exhaustive search in scientific databases using rigorous eligibility and clinical relevance criteria. Results: Locoregional flaps are an effective and versatile option for the reconstruction of traumatized lower limbs, especially in settings with limited resources or patients with comorbidities. Techniques such as the DIEP, Propeller and hemitriceps surae flaps provide reliable coverage, reduce complications and offer good aesthetic and functional results, being a valuable alternative to microsurgical flaps. Conclusions: The use of flaps for lower limb reconstruction is an effective, reliable, and adaptable technique that improves the functional and aesthetic quality of life of patients. The appropriate selection of the technique depends on the characteristics of the defect, the patient's comorbidities, and the experience of the medical team. Although serious complications are not frequent, they should be carefully considered to minimize the risk of reconstruction failure. General area of ​​study: Medicine. Specific area of ​​study: Traumatology. Type of study: Literature review.