Posttraumatic Soft Tissue Coverage of the Lower Leg for the Orthopedic Surgeon

Lower extremity trauma care is common with many patients presenting with complex soft tissue injuries. Many orthopedic surgeons perceive such soft tissue injuries to be out of their scope of practice due to presumed complexity and need for microsurgical and vascular reconstructive techniques. In this review, common approaches to treating these injuries and the ease with which these skills may be acquired and executed are discussed. Neither microsurgery nor vascular surgery is required. Methods such as DPWC, NPWT, and piecrusting serve to decrease wound tension and increase rates of successful healing through primary closure. Superficial wound coverage with STSG can provide appropriate coverage in situations in which primary wound closure is unable be obtained. As wound complexity increases, local rotational soft tissue flaps may be necessary to cover exposed bone, tendon, or implants. A multitude of courses are available in the United States and abroad to provide education in wound coverage such as The Surgical Management and Reconstructive Training (SMART) Course, Advanced Techniques in the Management of Soft Tissue (AO North America), and the Soft Tissue Coverage Skills Course (Orthopaedic Trauma Association and Limb Lengthening and Reconstruction Society). The gastrocnemius, soleus, and reverse sural artery rotational flaps prove highly resourceful to the orthopedic surgeon and negate the need for microsurgery or potential delays when working with a multidisciplinary team.