Traumatic Lower Extremity Reconstruction in a Patient with Significant Vascular Comorbidities

Limb salvage after devastating traumatic injuries, cancer extirpation, and intrinsic disease is a complex decision-making process. Although several scoring and evaluation tools have been created to attempt to apply algorithmic decision-making to the process, thoughtful clinical decision-making remains the most important standard. When limb salvage is deemed appropriate, selection of a tissue flap for limb reconstruction is dependent on the size and location of the defect, patient comorbidities, nicotine dependence, mechanism of injury to the limb, patient lifestyle, occupation, and ambulatory status. This case involves a male trauma patient with significant comorbidities and a large lower extremity wound requiring multiple operations to attempt limb reconstruction with a rectus abdominis free flap. This patient’s complex injury and comorbidities made the risk of flap failure high, illustrating that the importance of patient- and case-specific factors cannot be overstated when planning for a limb reconstruction. This extreme resort of limb reconstruction, where limb loss is the only other option and a likely consequence of even heroic efforts, is aptly called “limb salvage”.