fig6

Figure 6. Algorithm for lower extremity reconstruction after composite resection for bone sarcoma. Defects of the proximal and mid-femur were successfully closed with primary closure in the majority of cases; backup options included pedicled ALT, and rectus abdominis flaps, and free flaps. Defects of the distal femur and proximal tibia were successfully closed with pedicled gastrocnemius flaps, often with inclusion of the soleus muscle. Backup options include distally-based pedicled ALT flaps, anterior bipedicled fasciocutaneous flaps, pedicled sural artery flaps, and free flaps. Defects of the mid- to distal tibia were successfully closed with primary closure in the majority of cases. Backup options include pedicled gastrocnemius and soleus flaps, propeller or keystone flaps, and free flaps. ALT: anterolateral thigh