Outcome of Free Flap Reconstruction for Composite Defects of the Lower Third Leg and Foot: A Prospective Observational Study

Open Access

Abstract

Introduction: Composite defects of the lower third leg and foot present major reconstructive challenges due to limited soft tissue availability, poor local vascularity, and frequent exposure of critical structures. Free flap reconstruction has become the gold-standard approach, yet outcome data from Bangladesh remain scarce. Methods & Materials: This descriptive observational study was conducted at Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh, from July 2015 to June 2017. Eleven patients with composite defects requiring free flap coverage were included. Demographics, etiology, defect characteristics, flap type, recipient vessels, and postoperative outcomes were recorded. Flap success was graded using the Srikant classification. Only descriptive statistics were applied. Results: The mean patient age was 45.45 ± 5.3 years, with a predominance of males (73%). Road traffic accidents were the most common cause of defects (55%), followed by tumor excision (27%). Defects ranged from 8 × 5 cm to 20 × 7 cm. The anterolateral thigh (ALT) flap was the most frequently used flap (73%), and the anterior tibial artery served as the recipient vessel in 82% of cases. According to the Srikant system, 100% flap survival was achieved, with 73% classified as Grade 1 (complete success without complications). No patient experienced complete flap failure, major morbidity, or amputation. Conclusion: Free flap reconstruction is a highly reliable option for managing complex composite defects of the lower third leg and foot, even within resource-limited settings. The high flap survival rate and absence of catastrophic complications demonstrate the feasibility and effectiveness of microsurgical reconstruction in Bangladesh.