Orthoplastic and Radiological Approach to Complex Acute and Chronic Injuries of the Lower Extremities

Introduction: Management of fractures or osteomyelitis with accompanying soft-tissue damage in the lower extremities remains challenging. This study evaluated the effectiveness of a multidisciplinary orthoplastic approach in patients with severe bone and soft-tissue defects of traumatic or infectious origin. Particular attention was given to the role of radiological techniques—Doppler ultrasound and Angio-CT—in preoperative planning. Imaging provided essential information on the number, location, size, and branching patterns of perforators, supporting functional and aesthetic outcomes. Material and Methods: This retrospective case series included 27 patients treated between May 2021 and December 2023. Group A comprised 17 patients with acute post-traumatic bone and soft-tissue loss, and Group B included 10 patients with chronic osteomyelitis, fistula, and soft-tissue defects. Treatment involved multidisciplinary reconstruction using local and free flaps following radiological assessment. Bone stabilization was achieved with low-contact locking plates or intramedullary nails. In osteomyelitis cases, polymethyl methacrylate bone cement served as a filler and local antibiotic carrier. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Osteomyelitis and open fractures were classified according to Cierny–Mader and Gustilo–Anderson systems. Fourteen patients undergoing propeller or ALT flaps received preoperative Doppler ultrasound and CT angiography. Results: Mean follow-up was 17.9 months in Group A and 24.4 months in Group B. Doppler ultrasound findings were consistent with Angio CT results, with no false-positive perforators confirmed intraoperatively. Ultrasound additionally provided information on flow velocity and vessel diameter, supporting surgical planning. No infection recurrence was observed, and bone union was achieved in all patients. LLFI scores improved significantly (p<0.05), and all patients reported satisfaction with outcomes. Conclusion: A collaborative orthoplastic approach ensures favorable outcomes in complex lower limb reconstruction. Radiological assessment, particularly Doppler ultrasound, plays a key role in flap planning and may serve as a reliable standalone preoperative tool. Combined radical debridement, stable fixation, flap reconstruction, and local antibiotic therapy effectively manage complex orthoplastic conditions.