The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally, the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review, the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

中文翻译：

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创伤后下肢软组织重建的现代方法

骨科和整形外科医生经常遇到复杂的下肢伤口。伤口护理、软组织覆盖和手术固定技术方面的创新可以改善这一高度病态损伤患者群体的功能结果。在这篇综述中，概述了复杂下肢创伤性伤口的重建原则。这些原则包括对患者和受损肢体进行适当的初步评估，以及为保肢选择适当的患者。作者强调重建的适当规划、重建的时间安排以及了解最合适的重建方案的重要性。讨论了不同重建和伤口护理方式的作用，特别是负压伤口治疗和真皮替代物。讨论了带蒂皮瓣和微血管游离组织转移的作用，以及对穿支解剖和穿支皮瓣手术的理解的创新，这些创新拓宽了重建外科医生的设备。最后，通过矫形方法治疗复杂下肢伤口的原则，强调了多学科团队的重要性。读完这篇综述，读者应该对当代下肢重建的原理有一个透彻的了解。多学科团队的重要性通过矫形方法的原则来处理复杂的下肢伤口得到了强调。读完这篇综述，读者应该对当代下肢重建的原理有一个透彻的了解。多学科团队的重要性通过矫形方法的原则来处理复杂的下肢伤口得到了强调。读完这篇综述，读者应该对当代下肢重建的原理有一个透彻的了解。