The problems of traumatic skin loss of the lower limbs, especially when associated with skeletal injury

The problems relating to the management of traumatic skin loss of the lower extremity are discussed in Part I of this paper. A short historical survey suggests that the two specialities of orthopaedic and plastic surgery should combine in the treatment of these injuries. This is followed by some anatomical considerations which have practical application in reconstructive surgery of the lower limbs. Principles of treatment are laid down, with the intention that a normal and fully functional limb can be obtained by such combined treatment, provided there are no factors which limit reparative surgery. The available methods of skin replacement and their application to different types of injuries are discussed. In Part II, 135 compound fractures of the lower extremity are reviewed. These comprise 42 compound fractures of the small bones of the foot and 93 cases of compound fractures of the remainder of the large bones of the lower limb, including open knee- and ankle-joints. The methods of analysis are mentioned and the results documented by a number of tables. The discussion which follows rationalizes a plan for management.