Old School vs. New School: Balancing Traditional and Contemporary Approaches in Lower Extremity Reconstruction Saturday, October 17 Sat, Oct 17 8:00-9:30 a.m. CDT

This panel will be interactive and encourage a lively debate among panelists and the audience. Lower extremity reconstruction has undergone a profound transformation over the past two decades. Traditional approaches, following the reconstructive ladder, remain reliable and widely practiced. These approaches include locoregional flap options, robust muscle and fasciocutaneous flap coverage when free tissue transfer is necessary, staged orthoplastics reconstructions, and microvascular anastomoses to main-line vessels. At the same time, contemporary strategies, including microsurgery for middle and proximal third defects, supermicrosurgical approaches, superthin free flaps, single-stage vascularized bone reconstruction, and perforator-to-perforator anastomoses, have gained popularity and may expand what is possible in limb salvage.

This panel will present a side-by-side comparison of fundamental and innovative philosophies across common lower-extremity scenarios: open fractures, oncological defects, chronic wounds and osteomyelitis, and composite soft-tissue, bone, and nerve defects. Faculty representing different practice styles will debate indications, timing, resource utilization, and expected outcomes.

The goal is to give surgeons practical, real-world insight into when to stick with traditional fundamental approaches, when to adopt contemporary techniques, and how to blend both approaches to improve outcomes and expand practice responsibly.

Upon completion of this learning activity, participants should be able to:

1. Identify and compare the strengths and weaknesses of traditional approaches versus contemporary approaches to lower extremity reconstruction.

2. Discuss patient and defect characteristics that favor conservative vs. innovative approaches.

3. Apply case-based algorithms to common lower-extremity problems where controversy exists.

4. Integrate lessons from both philosophies to optimize decision-making and expand reconstructive options safely.

5. Understand resource, training, and practice considerations that influence whether to adopt new approaches or maintain traditional strategies.