Arch Plast Surg.  2019 May;46(3):255-261. 10.5999/aps.2017.00892.

Use of the cross-leg distally based sural artery flap for the reconstruction of complex lower extremity defects

• Liang W
• Tan BK

• KMID: 2450936
• DOI: http://doi.org/10.5999/aps.2017.00892

Abstract

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.

Keyword

Leg injuries; Sural nerve; Perforator flap; Surgical flaps; External fixators

MeSH Terms

Arteries*
Bandages
Estrogens, Conjugated (USP)
External Fixators
Free Tissue Flaps
Heel
Humans
Immobilization
Leg Injuries
Lower Extremity*
Perforator Flap
Sural Nerve
Surgical Flaps
Tissue Donors
Wounds and Injuries
Estrogens, Conjugated (USP)