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Free Flaps in Re-constructive
surgery of the Lower Limb
Dr Subrat Jena
Ashwini Hospital
Cuttack
Selection of flap
Location, size and shape. Age, sex and
co-morbid states including nature and
location of other injuries.
Training, experience and comfort levels of the surgeon:
Surgeon’s privileges
Free flap reconstruction ladder
• Like the first step of the ladder is the
easiest to ascend; the first choice of the
flap should be the easiest for the surgeon.
• The flaps available to us, therefore, should
be classified according to the difficulty
grades, rather than the ‘most ideal one’ for
a given situation.
Free Radial Flap
Difficulty level - 1
Great Toe reconstruction
Free A L T Flap
Difficulty level - 2
Sole and medial ankle Heel
Heel and mid-foot areaDistal foot-dorsal and plantar
Amputation stump
Free L D Flap
Difficulty level - 3
Sensate heel pad
Free Rectus Abdominis
Muscle Flap
Difficulty level - 4
Other free flapsDifficulty level - 5
• Free Gracilis (denervated / innervated)
• Free parascapular flap
• Free Groin Flap
• Free Superior glueal/inf. gluteal flap
• Free perforator flaps
Thank You