Purpose Statement: We present a retrospective review of six patients who underwent successful VAC therapy as an adjunct to failed free tissue transfer, or as a replacement to free tissue transfer in lower extremity salvage.

Materials and Methods: Between March 2002 to November 2002, 6 patients were identified meeting the above criteria. Age, indications for free tissue transfer, wound type, time on VAC therapy to successful soft tissue coverage, time to ambulatory activities, and complications were parameters analyzed.

Results: Patient age ranged from 6 to 65. Indications for free tissue transfer included exposed tendon, bone, or neurovascular structures secondary to trauma, tumor ablation, infection, and burn. Average time on VAC therapy was 27 days. Average time to ambulation was 17 days. No patient died or underwent amputation as result of therapy.

Conclusion: VAC therapy and skin graft can serve as an adjunct to failed free tissue transfer for lower extremity reconstruction and can also serve as a replacement to free tissue transfer in those patients who are not candidates; this may force us to reconsider classic indications for free tissue transfer.