Lower extremity reconstructions tend to be a difficult and challenging problem. All too frequently microsurgical free flap reconstruction is used when perhaps a less involved, less tedious, and more creative option is available.

Local tissue reconstruction of the lower extremity, most notably distal third tibia defects seems to be a lost art. We will present our series of local flaps to this difficulty area with more than 1 year follow-up.

The most reliable flaps we have found include the lateral supramalleolar, sural fasciocutaneous and sural musculo-fasciocutaneous flap. We will describe our techniques, successes, and pitfalls over the last 5 years in using these creative alternatives to micorsurgical free flap reconstructions.

It is with the plastic surgeon outside of the major tertiary hospitals that these techniques are perhaps most useful. We will compare the utilization of resources with the more labor intensive microsurgical procedures.

In summary, the reconstructive surgeons should develop a wider armamentarium of local flaps and perhaps not jump the reconstructive ladder to microsurgery when treating these difficult problems.