Arch Hand Microsurg.  2019 Jun;24(2):183-188. 10.12790/ahm.2019.24.2.183.

Revisiting the Cross-Leg Flap: A Degraded or Still Useful Method?

• Yu HH
• Choi Y

• KMID: 2448053
• DOI: http://doi.org/10.12790/ahm.2019.24.2.183

Abstract

Since the development of microsurgery, the cross-leg flap has not been a preferred method of lower extremity reconstruction. However, it is being used in several centers and has shown favorable results. This report presents our experience in treating lower extremity injuries using the cross-leg flap. We studied three patients with lower extremity defect who underwent cross-leg flap surgery. As there was no proper perforator for local flap or recipient vessel for free flap in the ipsilateral leg, two underwent the posterior tibial artery island cross-leg flap and one had the latissimus dorsi free flap, wherein the recipient vessels comprised the contralateral posterior tibial vessels. All procedures were successful without any severe complications. We recommend that cross-leg flaps be considered not only in cases of multiple vessel injuries or when no other options are available but also in cases of broad trauma or where scar tissue is present around the defect.

Keyword

Lower limb; Injuries; Reconstructive surgery; Wounds; Surgical flaps

MeSH Terms

Cicatrix
Free Tissue Flaps
Humans
Leg
Lower Extremity
Methods*
Microsurgery
Superficial Back Muscles
Surgical Flaps
Tibial Arteries
Wounds and Injuries

Figure

• 

  Fig. 1 (A) Preoperative defect on the right knee with exposed fractured patella. (B) A latissimus dorsi free flap was used to cover the right knee defect. The flap pedicle was anastomosed to the contralateral tibial vessels. The exposed muscle of the flap was covered with a split-thickness skin graft. (C) Both legs were fixed with external fixators. (D) Three years after the operation. There was no hypertrophic scar, contracture, or joint stiffness.

• 

  Fig. 2 (A, B) The metal plate and fractured bone were exposed on the defect site. (C) The defect was covered using a fasciocutaneous flap anastomosed to the contralateral posterior tibial artery. (D) The pedicle including the posterior tibial vessel of the contralateral leg was covered with a split-thickness skin graft. (E) Casts, instead of external fixators, were used for both legs and ankles. (F) Two years after the operation.

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  Fig. 3 (A) The calcaneus was exposed on the heel area. (B) The defect with bone exposure was covered with a fasciocutaneous flap anastomosed to the contralateral posterior tibial artery. The exposed pedicle was covered with a split-thickness skin graft. (C) Both legs were fixed with external fixators. (D) Seven years after the operation. There was no scar contracture, only pigmentation.

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