American Society of Hirudotherapy

Lower extremity microsurgical reconstruction

Review published in Plastic and reconstructive surgery (2001)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical LiteratureHeller et al. · Plastic and reconstructive surgery, 2001

Abstract

After studying this article, the participant should be able to: 1. Understand the indications for the use of free-tissue transfer in lower extremity reconstruction. 2. Understand modalities to enhance the healing and care of soft tissue and bone before free-tissue transfer. 3. Understand the lower extremity reconstructive ladder and the place of free-tissue transfer on the ladder. 4. Understand the specific principles of leg, foot, and ankle reconstruction. 5. Understand the factors that influence the decision to perform an immediate versus a delayed reconstruction. Free-tissue transfer using microsurgical techniques is now routine for the salvage of traumatized lower extremities. Indications for microvascular tissue transplantation for lower extremity reconstruction include high-energy injuries, most middle and distal-third tibial wounds, radiation wounds, osteomyelitis, nonunions, and tumor reconstruction. The authors discuss the techniques and indications for lower extremity reconstruction.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsBone NeoplasmsCosts and Cost AnalysisForecastingHumansInformed ConsentLegLeg InjuriesMicrosurgeryOrthopedic ProceduresPlastic Surgery ProceduresSoft Tissue NeoplasmsSurgical FlapsTissue and Organ Harvesting

Summary

This CME review covers microsurgical free-tissue transfer for lower extremity salvage, discussing indications such as high-energy injuries, middle and distal-third tibial wounds, radiation wounds, osteomyelitis, nonunions and tumor reconstruction, along with timing and reconstructive-ladder principles.

Context

This review discusses indications, techniques, and principles for lower extremity microsurgical reconstruction using free-tissue transfer, covering scenarios such as high-energy injuries, radiation wounds, osteomyelitis, nonunions, and tumor reconstruction. The authors outline the reconstructive ladder and factors influencing immediate versus delayed reconstruction. The abstract does not mention leeches, hirudotherapy, or the leech secretome. Medicinal leeches are sometimes used adjunctively in microsurgical flap salvage for venous congestion, but this application is not referenced in the abstract.

Citation

Reference (Vancouver style)

Heller L, Levin LS. Lower extremity microsurgical reconstruction. Plast Reconstr Surg. 2001;108(4):1029-1041; quiz 1042. doi:10.1097/00006534-200109150-00036. PMID: 11547168

Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.

DOIPubMed

Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026

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