Free Flaps in Re-constructive

surgery of the Lower Limb

Dr Subrat Jena

Ashwini Hospital

Cuttack

Selection of flap

Location, size and shape. Age, sex and

co-morbid states including nature and

location of other injuries.

Training, experience and comfort levels of the surgeon:

Surgeon’s privileges

Free flap reconstruction ladder

• Like the first step of the ladder is the

easiest to ascend; the first choice of the

flap should be the easiest for the surgeon.

• The flaps available to us, therefore, should

be classified according to the difficulty

grades, rather than the ‘most ideal one’ for

a given situation.

Free Radial Flap

Difficulty level - 1

Great Toe reconstruction

Free A L T Flap

Difficulty level - 2

Sole and medial ankle Heel

Heel and mid-foot areaDistal foot-dorsal and plantar

Amputation stump

Free L D Flap

Difficulty level - 3

Sensate heel pad

Free Rectus Abdominis

Muscle Flap

Difficulty level - 4

Other free flapsDifficulty level - 5

• Free Gracilis (denervated / innervated)

• Free parascapular flap

• Free Groin Flap

• Free Superior glueal/inf. gluteal flap

• Free perforator flaps

Thank You