Long-term evaluation of patients with free tissue transfer to the lower leg in terms of functional, socioeconomic, and esthetic aspects

A retrospective, quantitative, long-term evaluation of patients with a free flap transfer to the lower extremity was carried out with respect to functional, socioeconomic, and esthetic outcome. The study included 57 patients who were examined by questionnaire filled out by both an examiner and the patients themselves. Indications for the free flaps were acute trauma or osteomyelitis and unstable scars arising from a previous trauma to the lower leg. The flap success rate was 94.7%. The period between the operation and evaluation was at least 3years. A local, flap-specific functional impairment was found in 17 patients (30%) and a general impairment of the lower extremity in 56% of the subjects. With respect to the socioeconomic outcome more than two-thirds of the patients returned to their previous occupation with no restrictions; approximately 20% of subjects had to switch to a less strenuous job. Although from the viewpoint of the examiner the esthetic appearance was satisfactory in 44 free flaps (77%), the majority of the patients were conscious of pigmental, textural, or contour changes which produced a subjective esthetic compromise in 56% of cases. In conclusion, despite a considerably high rate of local functional impairment the majority of patients (89%) were satisfied and judged the application of a free flap as having been beneficial in preventing a loss in socioeconomic status. The high rate of esthetic problems demonstrates the importance of including esthetic considerations in designing the free flap, in particular with regard to (a) meticulously tailoring the flap, (b) aiming at a homogeneous skin surface, and (c) thoroughly shaping the affected lower extremity