Aesthetic microsurgical reconstruction of the female lower leg

In the true sense of the term, “aesthetic reconstruction of lower leg” means that patients accept the appearance of their reconstructed lower leg(s) and are willing to go outside in short trousers or a knee-length skirt without feeling embarrassed. Because of this, soft tissue reconstruction of large areas of the female lower leg is especially challenging. In this paper, we focus on the “aesthetic reconstruction of the female lower leg” and discuss this problem and its solutions. Case 1 was a 25-year-old patient with an avulsion injury. A 13 × 25-cm muscle-sparing transverse rectus abdominis (TRAM) flap was used for the reconstruction. However, in addition, a free groin flap and parascapular flap were added to reconstruct the whole lower leg over a 2.5-year period. Case 2 was a 25-year-old patient with a soft tissue defect. A 15 × 30-cm muscle-sparing TRAM flap was used for the reconstruction. In retrospect, it was clear that the texture and color of the TRAM flap resembled those of the lower leg reasonably well. We suggest that the muscle-sparing TRAM flap or the deep inferior epigastric perforator flap should be a first choice of tissue for the reconstruction of the female lower leg, especially when aesthetics and donor-site morbidity are taken into consideration.