Lower Extremity Reconstruction, Foot

Background: The leg is a complex district with functions of weightbearing support, stability, and motility. The osseus structure of the lower leg is composed of the tibia and the fibula. The tibia is most responsible for lower leg functions, while the fibula is a fairly expendable bone. Occasionally, traumas, neoplasms, or acquired or congenital malformations affect the tibia, inhibiting leg functions and consequently necessitating bone reconstruction or substitution. Small bone defects of the tibia are treated with external fixation and cancellous bone grafting, with satisfactory results. The management of extensive and complex defects is more challenging and often results in leg amputation or shortening. Leg amputation is a severe mutilation that alters the patient's work and social life by limiting ambulation and self­sufficiency. Limb shortening is also responsible for an asymmetric gait and posture deformities. In the last 20 years, the advent of microsurgery and its application to bone transfers has radically changed the treatment of complex tibial injuries, allowing plastic surgeons to reconstruct wide bone gaps with optimal functional, morphological, and cosmetic outcome—in most instances, avoiding the need for limb amputation or shortening. Free vascularized fibular transfer has become the standard practice to bridge long (>6 cm) bone defects of the extremities.