Soft Tissue Reconstruction of the Distal Third Tibia

Abstract

Wounds in the distal third of the tibia can be considered the most challenging for reconstruction and lower extremity salvage. This “no man’s land” provides very limited local reconstructive options because of its paucity of soft tissue laxity and redundancy. To this end, most reconstructive surgeons view distal-third injuries as requiring free tissue transfer for adequate soft tissue reconstruction. In limited circumstances, however, there are several viable options for local, pedicled soft tissue reconstruction in the distal third. These include the reverse sural artery flap, bipedicled flaps, propeller perforator flaps, and keystone flaps.