Occasions for multiple flaps in lower-limb reconstructions: once is sometimes not enough.
A retrospective review of 11 patients with complex and massive lower-limb defects requiring multiple transfers and/or regional muscle flaps for closure, found that microvascular transfers achieved final wound closure, either alone or in concert with local flaps, in all but one case. A local flap alone was not sufficient for any failed transfer reconstruction. This suggested that transfers are not only the best initial approach for massive lower-extremity defects, but they are sometimes the only solution available in complex lower-limb reconstruction, often when other options have failed.