Seventeen patients with full-thickness skin loss complicating
orthopaedic problems of the lower part of the leg and the foot underwent
free groin-flap transfer. Free flaps were used because more conventional
means of coverage had failed or were deemed inappropriate. Nine patients
had uncomplicated one-stage flap transfer. Three had peripheral necrosis
but required no further procedures. Five patients had superficial necrosis
of more than one-fourth of the flap, but split-thickness skin grafts
applied to the viable subdermal portion of the flap provided an adequate
surface in all but one of them. Necrosis was considered to be a result of
anastomosis to scarred recipient vessels or of unexplained vessel
thrombosis. It may be circumvented in part by the use of interposed vein
grafts, or proximal extension of the flap along the recipient vascular
tree.