World warfare necessitated the advancement of treatment of the traumat
ized lower extremity. Wound excision, immobilization and early seconda
ry suture had been established by the end of World War I. Conservative
debridement of skin with radical removal of devitalized subcutaneous
tissue and muscle was expanded to include myoplasty as a biologic cove
r for exposed bone. The literature reports separate series including b
one debridement and microvascular free-tissue transfer for soft-tissue
reconstruction versus pedicle muscle flap reconstruction. Our series
of three patients involved the combined use of pedicle flap and free-m
icrovascular muscle transfer with skin grafting to achieve reconstruct
ion of near total lower extremity skin avulsions and massive soft tiss
ue loss. This proved to be a very effective method for achieving biolo
gic coverage and function in these patients. This article reviews the
history of reconstruction of the severely traumatized lower extremity
and then compares our series with the accepted standard treatments fou
nd in the literature.