Lower Extremity Reconstruction

Lower extremity reconstruction, a practical guide

An integral part of plastic surgery, lower extremity reconstruction is centered on treating wounds and defects secondary to trauma, sarcoma (cancer) surgery, deformity, or chronic disease. These “lower extremities” encompass hips to toes.

The overall goal for lower extremity reconstruction plastic surgery is to cover defects and open wounds in the leg, allowing patients to continue their active life with the use of their leg(s), return to work, and avoid amputation.

One potential complication of this reconstructive surgery is lymphedema – or fluid build-up in the soft tissue.

Lower Extremity Reconstruction

Why would I need lower extremity reconstruction surgery?

Typical reconstruction cases often result from:

  • lower extremity trauma
  • a non-healing wound (which often occurs in patients with diabetes)
  • an illness that causes soft tissue or bone loss
  • tumor excision
  • peripheral nerve damage

It is critical to address open wounds immediately. An exposed bone that is not covered by soft tissue is at risk for osteomyelitis, bone necrosis, or sepsis. Osteomyelitis is a major cause of limb amputation.

Open wounds on the lower extremities may also cause acute pain, which makes it difficult or impossible to walk or continue daily activities. Exposed tendons in the leg may become dry and die, and exposed blood vessels are at risk of rupture.

Dr. Saber possesses the orthopedic technical skill to repair bones, tendons, muscles, blood vessels, nerves, and skin. Though some patients can be healed after only one surgery, those with more complex cases often need several follow-up surgeries. 

Lower limb reconstruction

The following is a partial list of lower-limb reconstruction surgical procedures performed by Dr. Saber.

Skin flaps, muscle flaps, and local tissue rearrangement for the reconstruction of larger open wounds

Lower extremity flap coverage uses the tissue adjacent to the wound to cover moderate defects in the legs such as exposed bones, blood vessels, and tendons. Unlike a skin graft, a flap is transferred with an intact blood supply and remains connected to its origin.

Skin flaps are used when the injury has lost tissue and is too big for the edges to be brought together correctly. The flap is fed by the same blood supply where it was taken until new blood vessels grow. A flap provides the benefit of supplying tissue of similar appearance and thickness so the cosmetic result is superior to a skin graft.

Vascularized skin flaps typically heal faster than skin grafts. Plus, you don’t have to create a separate wound on another part of the body.

Skin grafts

For a skin graft, the doctor takes healthy skin from one part of the patient’s body (donor site) and transplants it to the site of injury. After just a few days, the graft develops blood vessels and connects to the skin around it. Skin grafts are particularly effective when patients suffer from burns, wounds, disease, or infection.

Lower Extremity Reconstruction

Though most plastic surgeons use healthy skin from a person’s body (autograft), if there is not sufficient healthy skin, the surgeon may use skin from a cadaver (allograft). It should be noted that animal skin grafts are usually temporary until the patient grows new, healthy skin.

Skin for a skin graft often comes from:

  • Abdomen
  • Back and chest
  • Buttocks or groin
  • Collarbone
  • Forearm
  • Inner thigh, outer thigh, and hip

Sometimes, there isn’t enough healthy skin on a person’s body to use for the procedure. If this happens, a provider may take the skin from a cadaver (allograft). If a cadaver cannot be readily found, doctors also may use the skin from an animal, such as a pig (xenograft).

Surgical soft tissue coverage of exposed knee prosthesis

In recent years, with an aging population, total knee arthroplasty (knee replacement) has become more prevalent, which makes complications inevitable. Sometimes, a lower extremity injury can leave a prosthetic knee exposed. Physicians have discovered that it is possible to save the knee with lower extremity free tissue transfer, even if an infection has set in.

Case reports confirm that a free flap over the exposed knee prostheses has a high limb salvage rate – often alleviating the need for amputation.

Surgical soft tissue coverage of exposed fractures, hardware, bone, tendons, synthetic conduits/mesh, or neurovascular structures

Open fractures are extra worrisome because not only is the bone damaged, the body’s protective skin barrier is broken and the risk of infection is high. Between 3.5 and 6 million fractures occur in the United States each year, with about 3% of those being open fractures. There are different treatment options depending on the status of the soft tissues surrounding the fracture site. The goals of treating an open fracture are to prevent infection, knit the bones, restore function, and cover the wound with soft tissue reconstruction. Important aspects of wound healing are rapid surgical timing, wound closure, a tetanus shot, and wound irrigation.

Why Dr. Saber is the best plastic surgeon for Lower Extremity Reconstruction in Los Angeles?

Dr. Sepideh Saber, MD, FACS, offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Patients from all walks of life have praised not only their final outcomes but her caring, thoughtful approach to all types of appearance and health-related matters. 

Dr. Saber graduated from Stanford University’s world-renowned medical school and did her reconstruction and plastic surgery residency at the University of Southern California (USC). She then completed a fellowship at New York University (NYU) in the extremely challenging and delicate area of hand surgery, as well as microsurgery.

To request a free consultation, call (877) 205-4100 or schedule a consultation online.

The practice of Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.

Studies of Interest

Hidalgo DA, Carrasquillo IM. The treatment of lower extremity sarcomas with wide excision, radiotherapy, and free-flap reconstruction. Plast Reconstr Surg. 1992;89(1):96-102.

Nahabedian MY, Mont MA, Orlando JC, Delanois RE, Hungerford DS. Operative management and outcome of complex wounds following total knee arthroplasty. Plast Reconstr Surg. 1999;104(6):1688-1697. doi:10.1097/00006534-199911000-00012

What patients say about Dr. Saber

Over 16 Reviews

I was fortunate to find Dr. Saber after researching board-certified surgeons who specialize in breast cancer reconstruction revision surgery. I knew I was in good hands from the moment I spoke with the lovely and efficient Marlene, Dr Saber's office manager. Dr Saber patiently listened to my concerns and, after examining me, explained what I could realistically expect the outcome to be from another surgery. She also explained to me that she would need to review my previous surgery notes before we could discuss a possible further surgery, which I found comforting and highly ethical. I also discussed a couple of other procedures that I would like done, including fat removal from my large upper arms that had caused me great embarrassment for several years. Dr. Saber is an excellent surgeon who is incredibly kind and genuine. She truly understands the female body and the emotional aspect of body insecurities yet, she is transparent about what can and cannot be done and takes time to discuss realistic expectations and outcomes. My breast reconstruction revision surgery will take place in the New Year, but in the meantime, I have the most fabulous upper arms that I recently flaunted in a strapless dress (something I have not done in years). Dr Saber is truly one of a kind, and I still cannot believe how fortunate I am to have found her. I highly recommend Dr Saber.

Linda DeCarlo November 29, 2023

I don’t have enough wonderful words to describe Dr Saber and Marlene! I had a tummy tuck done this year and from start to finish the entire experience was amazing. Marlene is always so helpful and works so hard to make every detail a breeze for you. When I had my consultation with Dr Saber I was at a point of complete agony with my body. She instantly took that stress and frustration off my shoulders! As a woman not being heard by doctors for years I left that consultation with happy tears knowing I had finally found my Dr. It was a major surgery and I felt completely zen and at peace going in because she really does make you feel that safe. I didn’t think I would ever look the way I do now! She gave me the gift of having the body I kept fighting for. I will never stop recommending her.

Monica Prusa October 9, 2023

I saw Dr. Saber when I broke my wrist. I ended up having to have surgery. She did an excellent job and I am healing nicely. She was very professional, but was also very kind and compassionate. I would highly recommend her!!

Sandy Schaupp September 13, 2022

I LOVED DR SABER!!! There are a few reasons why I chose her. One was because she’s a female Doctor that was my goal who also did a good job (which I was able to confirm with all her before and after photos) and what sold me was my safety in mind. She made me feel like I was in the best hands ever along with Marlene who coordinated everything THANK YOU LADIES! Dr Saber helped me get back the body I have always desired. I had a lot of stomach fat from weight gain and I lost weight so a lot of my weight was in my front lower and upper abdomen. Now I have a super beautiful curvy body like an hourglass after a tummy tuck and lipo she did. She understood the assignment hahaha . I’m 32 years old no kids just wanted to enjoy my younger body looking and feeling beautiful and she really took good care of me. Even after hours I had an emergency due to my fault but she was there and got back to me very quickly and I’m very grateful. I also think her work says a lot because I stopped taking pain medication on the 3rd day after surgery and was fine with very minimal pain I was able to tolerate the healing process. Highly recommend going with her I just had a wonderful experience and would do it all over again if I had too. Maybe after I have kids. Thanks Dr Saber and team <3

STEPHANIE d July 15, 2022

Dr.Saber is by far one of the best plastic surgeons. I love how she takes her time to explain any procedure to the patients understanding. She always makes sure to answers any and all questions.From fillers to body contours she’s the one you want.

Katherine Melara February 15, 2022

Dr Saber is amazing! She is caring and very informative. I went in for fillers and she explained procedure step by step. I highly recommend her and look forward to future visits.

Amanda Vazquez December 18, 2020

Dr. Saber was friendly, knowledgeable and professional. She took time to listen, answer all my questions and was forthright in her recommendations. Her staff was friendly and helpful. I was very happy with the results and plan on going back. If you are looking for a first rate professional experience look no further she is the doctor for you!

T R December 18, 2020

Dr. Saber is one of a kind plastic surgeon with a heart of gold. She is a well verse plastic surgeon that puts her patient's needs before anything else. She genuinely cares about every single patient, and her work speaks for itself. I notice every post-operative result on her Instagram (@saberplasticsurgery) the patients have this glow that radiates through. I have been going to Dr. Saber for my Botox for the past 3 years, and love the results every time. I know who I will be going to for any future plastic surgery needs, and will confidently refer family and friends to Dr. Saber for any Botox, fillers, and plastic surgery consultations.

Rudy Garcia December 16, 2020

I have nothing but great things to say about Dr. Saber! I am so pleased with my results from a breast augmentation she performed on me back in late June! She answered all my questions and concerns before and after my surgery. She’s very easy to get in contact with and she’s so nice. She made feel so comfortable throughout the whole process. 100/10 Lover her work!!

Amanda Villegas October 15, 2020

Dr Saber is hands down the best surgeon! She took her time answering my questions and explained procedure in detail. After doing liposuction six months ago, I am extremely happy with my results and I appreciate her so much.

Marlene Cosentino October 15, 2020

Dr. Saber is so kind and thorough with her patients! She is an amazing doctor and genuinely cars about everyone she comes in contact with. I would recommend her to anyone for any hand surgery or cosmetic procedure.

Rachel Meach October 15, 2020