الفهرس 
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Abstract
Conclusion
Traumatic leg and foot defects require collaboration between specialized plastic, vascular and orthopedic surgeons to ensure excellent vascular, bone and soft tissue assessment and to obtain satisfactory and optimum management for the patient.
Resuscitation and management of major life-threatening injuries takes precedence over treatment of the injured lower limb. Priority should be given, therefore, to the identification and control of vascular injury in the immediate post-traumatic period.
Debridement of all devitalized tissue is crucial to final success of any reconstruction and often requires serial operative debridement prior to final wound coverage.
When free tissue transfer is indicated in leg and foot defects, the free ALT perforator flap is the flap of choice for reconstruction as it has many advantages as follow, high success rate, less functional donner site morbidity, better cosmetic results, good color and texture matching, long and wide caliber vascular pedicle, less hospitalization time, less operation time and less overall flap complications.
The free muscle-musclocutenous flaps ”free latissimus and free rectus muscle flaps” have the following advantages, high success rate, they can cover huge sized defects, better donner site cosmetic results, wide caliber vascular pedicle, robust blood supply to the recipient area and less need for secondary thinning operations.
The choice of the flap to cover leg and foot defects should be tailored according to favorable criteria as regarding patient age, defect site, size and depth, presence or absence of infections and the general condition of the patient.
Immediate presentation without delay, proper assessment, proper planning of the management, rapid intervention and postoperative follow up are the main keywords in achieving excellent results.
Summary
The foot is an especially important part of the lower limb because of its integrated function as both a sensor and an effector.
Leg trauma, with open high-energy soft-tissue and tibial injuries, most often occurs after motorcycle or car accidents and frequently requires plastic surgery involvement.
The free flap has been successfully used for lower extremity reconstruction for the past 40 years.
The aim of this work was to compare the outcome between free perforator and free muscle-musclocutenous flaps in leg and foot reconstruction as regarding flap versatility, operation time, early and late complications, hospitalization time, donner site morbidity and cosmetic results.
The study was done on 26 patients with leg and foot defects of different causes attended to the microsurgery unit in Assuit University Hospital and emergency unit and outpatient clinic of plastic surgery department in Sohag University Hospital in the period between June 2013 and May 2014.
The patients were classified into two groups, group 1 where free skin perforator flap was used for reconstruction “free ALT perforator flap group” and group 2 where free muscle-musclocutenous flaps was used for reconstruction “free latissimus dorsi and the rectus abdominis flaps `
Motor car accident was the commonest cause of injury in leg and foot defect accounting for 92.3% of cases and only one case due to firearm injury and one case secondary to cast sore.
Complete flap survival was noticed in 24 cases which represent 92.3% success rate and 2 flaps were completely lost.
As regarding the age incidence, it was noticed that age was ranged between 4 to 21 years in group 1, while in group 2 it was ranged between 5 to 54 years
Defect size in group 1 was ranged between 70 to 198 cm with the mean size was 124.77 +\- 52.93 while in group 2 it was ranged between 60 to 725 cm with the mean size was 184.15 +\- 177.53.
The distribution of the flaps according to the location of the defect was in group 1 as follow; 2 cases in the leg, 2 cases in the ankle and 9 cases in the foot. While in group 2 was as follow; 4 cases in the leg, 1 case in the ankle and 8 cases in the foot.
The overall flap complication rate in group 1 was 15.4 %, while in group 2 was 30.8 %. In both groups only 1 case experience total loss, while the infection rate was higher in group 2 than group 1
Donner site in group 1 was closed by STG in all cases and the donner site morbidity was 38.5 %. In group 2 all cases were closed primary and the donner site morbidity was 30.8 %.
The rate of secondary procedures was higher in group 1 compared with group 2. The rate was 30.8% in group 1 (4 cases need secondary defattening), and the rate in group 2 was 15.4 % (2 cases need secondary thinning).
The follow up period was 6 months to 1.5 years post-operatively in both groups.
The free ALT perforator flap has many advantages as follow; high success rate, less functional donner site morbidity, better cosmetic results, good color and texture matching, long and wide caliber vascular pedicle, less hospitalization time, less operation time and less overall flap complications.
The free muscle-musclocutenous flaps ”free latissimus and free rectus muscle flaps” have the following advantages; high success rate, they can cover huge sized defects, better donner site cosmetic results, wide caliber vascular pedicle, robust blood supply to the recipient area and less need for secondary thinning operations.