Integrating ortho-plastic and free flap techniques in lower extremity reconstruction: A systematic review of outcomes and innovations

This systematic review examines the use of orthoplastic and free flaps in lower extremity reconstruction, focusing on their efficiency, complications, and innovations. The objective was to synthesize the existing evidence on functional outcomes and advances in the procedure, thereby informing contemporary clinical practice and guiding future research. A rigorous search across three databases PubMed, Embase, and Cochrane revealed 42 studies (published between 2010 and 2024) that included 2,150 patients who underwent lower limb reconstruction using orthoplastic methods or free flap operations. Analyses of the data were performed in terms of functional recovery, complication rates, and innovations. Other important findings suggest that the combination of orthopedic and plastic surgery (orthoplastic techniques) can significantly improve limb salvage rates (from 0% to 92%) and functional results, enabling patients to walk nearly normally in 78 percent of cases. The complication rate was decreased in free flap reconstructions, especially perforator-based flaps, and exhibits a lower rate (12-18% compared to 25-30% in conventional modalities) of complications due to superior tissue viability and accurate vascular connection. Innovations such as 3D-printed scaffolds and the integration of bioengineered tissue hold the potential to streamline both flap survival and aesthetics. These developments underscore the importance of multidisciplinary cooperation in achieving higher-quality results. These results suggest the need for individualized approaches to reconstruction based on patient-specific factors in a clinical setting. Long-term, cost-effectiveness, and scalability of new methods need to be investigated so that the protocols can be improved and the quality of life for patients undergoing reconstructive surgery can be enhanced.