Lower extremity reconstruction – stumps

Lower extremity area which comprises the following regions: buttocks, thighs, tibia and lower extremity can be damaged following injury or burns. Also, tumours may develop (benign or malignant) in the area requiring surgical removal and reconstruction of defect. In addition, chronic diseases such as diabetes may have complications –ulcers and necroses– requiring thus the contribution of a consultant Reconstructive Plastic Surgeon. Finally, we should not forget to mention pressure ulcers that can be formed in lower extremity, with most popular areas being the hip and the heel.

Regardless of the cause of the defect in lower extremity, Reconstructive Plastic Surgery is offering solutions by covering those defects. In several cases, solutions are provided by classic methods of Plastic Surgery, but in complex cases such as those where bone, nerves, blood vessels or tendons are exposed, tissue transfer techniques (pedicled or free flaps) are of utmost importance for wound closure. For these techniques, the usage of magnifying glasses and/or electron microscopy is necessary in order to achieve the definite result.

Even in cases where lower extremity salvage is not possible and amputation is required, the effort to save the knee joint is significantly important, in order the patient to be able to walk normally with a prosthesis. Lower extremity area is responsible for full weight bearing and walking. Consequently, their reconstruction in case of injury is important for maintaining quality of life.

Dr Karmiris will answer all your questions and will recommend you the most appropriate solution for an optimal and functional result.

What to expect at your first appointment:

 At your first appointment, you will discuss:

• what exactly is your functional issue and if lower extremity reconstruction is the appropriate treatment for you.
• your past medical history, if you are on any medication, vitamins or other herbal supplements, if you have any allergies or any other operations in the past
• coexisting conditions related to your problem
• if you smoke (if the answer is yes, how many cigarettes per day).

Afterwards, Dr Karmiris:

• will evaluate your general health condition and any other risk factors
• will take preoperative photographs
• will discuss with you all the possible surgical options, depending on your case
• will discuss with you all the possible results of the surgical procedure and any risks or potential complications, as described in the international literature and finally
• will discuss with you about the anaesthetic plan.

Preoperative check:

Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.

Also, it will be necessary to stop smoking preoperatively and immediately post-operatively as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.

The surgical procedure:

The type of the condition determines, to a large extent, the type of the operation as well as the method of anaesthesia which will be given. Small defects can be repaired with simple surgical techniques and by using healthy parts adjacent to the injury. However, complex or extensive lower extremity injuries often require the usage of specialized techniques that can be used by a consultant Reconstructive Plastic Surgeon. These may include the usage of special suturing methods in cases of tendons, blood vessels and nerves incisions, as well as transfer of tissue from other body parts, depending on the case, such as transfer from thigh area for coverage of tibia in case of amputated stump, in which there was insufficient soft tissue coverage. The operating time of the surgery and the patient’s stay in the clinic varies, depending on the case.

Post operatively:

Post operatively, the patient will be discharged on the same day if possible while in complex operations, patient’s prolonged length of stay is necessary. Depending on the type of the condition and the performed surgery, patients can take pain killers and antibiotics, depending on the case. In case of external sutures, they will be removed in about 10 to 15 days. Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op and when you will be seen for a follow up.

For more information regarding lower extremity reconstruction, book today your appointment with Dr Nikos Karmiris. The doctor will answer all the questions and will help you to find the most appropriate therapy, depending on your case.