The operative technique used was the standard approach so elegantly. Original article distal perforator based cross leg flaps. The pitfalls, however, have not been well documented in the literature. This is quite rele vant because the highest percentage of failure of free flaps is encountered in cases of resurfacing the traumatic defects of the distal leg and foot 3. Review of crossleg flaps in reconstruction of posttraumatic. A block of tissue with its own blood vessels flap is removed from the thigh and transpl. Even in tertiary care centers cross leg flaps is a viable procedure in failed free flap surgeries. The cross leg flap is a safe and reliable alternative to free tissue transfer in certain situations of lowerlimb trauma. The technique of transfer and the length of time required before pedicle division depend on the nature of the flap and the contact surface. Demographics, etiology of the reconstruction, type of flap used, donorsite vessels, defect size, operating time, time of. Materials and methods the study data were collected between 2007 and 2015, from cases involving the use of cross leg free. Revisiting the fasciocutaneous perforator crossleg flap. All patients were hospitalized during this period and received acetylsalicylic acid 100 mgday.
The cross leg flap has disadvantages, too, not only in that it causes discomfort to patients because it restricts the movement of the legs, but also in that it requires a secondary operation to isolate the pedicle. Use of local muscle flaps to cover leg bone exposures. Cross leg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage. Pdf repair of a wide lower extremity defect with cross. Eight cross leg free flap reconstructions were performed on seven patients between 1986 and 1993. Retrograde cross leg perforator flaps are reliable option in cases of failed free flaps, unavailable ipsilateral proximal tissue, damaged distal perforators and distal most defects of foot. In the past decade, applications of free tissue transfer for lower. Crossleg free flaps for difficult cases of leg defects. The important technical considerations are outlined. Soft tissue coverage of lower legfree flap plastic. Buchan ac 1978 the place of the crossleg flap in reconstructive surgery of the lower leg and foot. Crossleg as salvage procedure after free flaps transfer. Reconstruction of the lower extremity with crossleg free.
Like most of the proven procedures, cross leg flaps. The anterolateral thigh alt flap is indications for a cross leg free flap procedure are limited to another alternative for reconstructing large defects with the the following. The blood supply of such flaps is considered and the technique of operation is described. This technique, however, declined with the introduction of microvascular surgery and the free flap. Lower extremity limb salvage with cross leg pedicle flap. Reconstruction with cross leg free flaps ozkan et al. For flap revascularization, endtoend anastomosis in cross leg free flap procedure has some advantages, but it requires the elimination of one major artery of the. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis. For flap revascularization, endtoend anastomosis in crossleg free flap procedure has some advantages, but it requires the elimination of one major artery of the. The cross leg flap technique is a wellestablished method to cover soft tissue defects of lower extremity with exposed joints, tendons, bone, and. Reconstruction of the lower extremity with crossleg free flaps. Cross leg flaps are a good choice for reconstructing traumatized lower extremities, especially when free flaps cannot be used. Successful detachment of crossleg fasciocutaneous flaps on the. Crossleg pedicled free scapular flap for the repair of.
In these conditions, the cross leg flap could be a good choice for reconstructing the defects. Pdf salvage of severely mutilated lower limb using cross. Salvage of the lower extremity free flap using cross leg. The purpose of this report is to introduce the cross. Free excision of avascular scar tissue is essential. Here we describe a case in which free flap reconstruction had to.
Pdf repair of a wide lower extremity defect with crossleg. It is a vascularised free composite flap containing bone and muscle, with or without skin and provides reliable singlestage reconstruction with excellent functional and aesthetic results. Crossleg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. This article will describe the use of this technique in coverage of difficult leg and foot defects in 16 patients. When harvesting the osteocutaneous flap, the septum is harvested in continuity with the paddle of skin and fascia of the lateral leg. We know that muscle transposition improves the blood supply to the receiving region, contributing significantly to the treatment of infection and promoting. It should have priority over microsurgery, not just be an alternative to it.
The inclusion of fascia when raising a crossleg flap. In wellselected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. After diffusion of microsurgery since 1970, pedicled cross extremity flaps for lower limb wound coverage have been replaced by free tissue transfer, but in the aforementioned cases the cross leg flap can still be considered a simple and effective alternative. Prepping and draping internally rotate the leg to enable easier harvesting, by elevating the ipsilateral. Pedicled cross extremity flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades.
Four days following free flap reconstruction of his right leg, the patient was discharged to the plastic surgery ward where he continued to improve with no complications regarding his free flap reconstruction and 95% take of the skin graft covering the flap. The cross leg flap is an effective and simple method for treating traumatic lower extremity wounds. The cross leg fasciocutaneous flaps are less frequently indicated for distal leg and foot. The local flap has the disadvantage of limiting mobility. Pdf staged division of crossleg flap to enhance flap. Medical billing and coding procedure code, icd code. Reconstruction of the lower extremity using free flaps. Salvage of the lower extremity free flap using crossleg. When a free flap is contraindicated or after a free flap failure, the cross leg flap is still nowadays a possible option. When a free flap is contraindicated or after a free flap failure, the cross leg flap. Codes 1573215738 are described by donor site of the muscle, myocutaneous, or fasciocutaneous flap. The cross leg flap may also be employed, but due to the inconveniences caused to the patient by prolonged immobilization and the uncomfortable rest position, we prefer not to indicate it.
Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. When compared with the conventional cross leg flaps the discomfort, cross legging, joint stiffness and sore development are minimal. Repair of bilateral lower limb injuries using a free latissimus dorsi cross leg flap. The cross leg flap became widely popular during world war ii as a limb salvage technique to treat injuries sustained in battle. Crossleg free flap for limb salvage in the setting of. Free style puzzle flap as a cross leg pedicled flap. Cross leg free flaps have been described for reconstruction of leg defects in cases of trauma with no suitable recipient vessels in the vicinity of the defect. Pdf repair of bilateral lower limb injuries using a free.
The lateral intermuscular septum separates the lateral compartment muscles from the soleus. In these situations local cutaneous or muscle flaps cannot be used due to extensive soft tissue loss. However, with the advent of microvascular surgery and the introduction of the free flap in 1970, use of the cross leg flap and other distant flaps declined. The technique of transfer and the length of time required before pedicle division depend on the nature of the flap. An alternative method to free flap for distal leg and foot. A small portion of this a small portion of this muscle with its blood supply artery and vein and nerve can be transplanted in the face to replace the facial muscles. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using cross leg flaps. Limb salvage in an irradiated patient with limited recipient vessels leaves few options for reconstruction. Crossleg flaps journal of the american college of surgeons. In cross section, the interosseous membrane is seen in green, spanning from the tibia to the fibula. A crossleg free rectus abdominis flap, anastomosing to utilized carrier vessels of the contralateral noninjured leg, was used for reconstruction in six cases of extensive traumatic defects and deformities of a lower extremity. Free flap anterolateral thigh flap to lower leg reconstruction. Noordhoff ms, tang y 1997 crossleg free flaps for difficult cases of legs defects.
We describe our experience with cross leg flap in 5 patients for the reconstruction of difficult leg defects in which no possible other options. Distal perforator based cross leg flaps for leg and foot defects. To overcome this problem, a new modification is introduced to increase the contact surface area between the cross leg flap and its recipient bed by staged division of the cross leg flap. The combination of extensive soft tissue and bone loss make the use conventional cross leg fasciocutaneous flap very difficult. A new and safer anastomosis technique in crossleg free flap. Twentyseven crossleg free flap transfers were performed. The purpose of this article is to introduce the early experience of the authors with technique of the cross leg free flap in cases of severely mutilated limbs. Versatility of a crossleg free rectus abdominis flap for.
The vascularised free fibular flap fff is the most commonly used flap in head and neck for bony reconstruction. In order to reconstruct very extensive defects, the free cross leg flap and the free cable bridge flap have been described. Free flap reconstruction following lower leg trauma in the. Crossleg free flap for limb salvage in the setting of radiation.
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