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 lateral intermuscular septum separates the lateral compartment muscles from the soleus. Free flap reconstruction following lower leg trauma in the. Demographics, etiology of the reconstruction, type of flap used, donorsite vessels, defect size, operating time, time of. Cross leg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades.
The technique of transfer and the length of time required before pedicle division depend on the nature of the flap. We describe our experience with cross leg flap in 5 patients for the reconstruction of difficult leg defects in which no possible other options. Prepping and draping internally rotate the leg to enable easier harvesting, by elevating the ipsilateral. Soft tissue coverage of lower legfree flap plastic. However, there are certain difficult situations where the free flap cannot be employed and alternative methods are needed. In these situations local cutaneous or muscle flaps cannot be used due to extensive soft tissue loss. It should have priority over microsurgery, not just be an alternative to it. Crossleg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. Crossleg free flaps for difficult cases of leg defects. When a free flap is contraindicated or after a free flap failure, the cross leg flap is still nowadays a possible option. Reconstruction of the lower extremity using free flaps. Even when a free tissue transfer can be performed the risk of failure remains considerable.
The combination of extensive soft tissue and bone loss make the use conventional cross leg fasciocutaneous flap very difficult. The vascularised free fibular flap fff is the most commonly used flap in head and neck for bony reconstruction. The purpose of this report is to introduce the cross. When a free flap is contraindicated or after a free flap failure, the cross leg flap. Pdf repair of bilateral lower limb injuries using a free. The cross leg flap is an effective and simple method for treating traumatic lower extremity wounds. 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. The blood supply of such flaps is considered and the technique of operation is described. Eight cross leg free flap reconstructions were performed on seven patients between 1986 and 1993. Codes 1573215738 are described by donor site of the muscle, myocutaneous, or fasciocutaneous flap.
The cross leg flap became widely popular during world war ii as a limb salvage technique to treat injuries sustained in battle. The cross leg flap technique is a wellestablished method to cover soft tissue defects of lower extremity with exposed joints, tendons, bone, and. 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. These included three latissimus dorsi muscle flaps, three fibula osteomyocutaneous flaps, one tensor fascia lata myocutaneous flap, and one posterolateral thigh flap. Salvage of the lower extremity free flap using crossleg. In wellselected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. Crossleg flaps journal of the american college of surgeons. Cross leg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage. Free excision of avascular scar tissue is essential. A new and safer anastomosis technique in crossleg free flap. Even in tertiary care centers cross leg flaps is a viable procedure in failed free flap surgeries. Pdf staged division of crossleg flap to enhance flap. Noordhoff ms, tang y 1997 crossleg free flaps for difficult cases of legs defects. We know that muscle transposition improves the blood supply to the receiving region, contributing significantly to the treatment of infection and promoting.
The local flap has the disadvantage of limiting mobility. In cross section, the interosseous membrane is seen in green, spanning from the tibia to the fibula. This technique, however, declined with the introduction of microvascular surgery and the free flap. Surgeons have long sought an alternative to the crossleg flap. When harvesting the osteocutaneous flap, the septum is harvested in continuity with the paddle of skin and fascia of the lateral leg. 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. In the past decade, applications of free tissue transfer for lower. Crossleg pedicled free scapular flap for the repair of.
Crossleg free flap for limb salvage in the setting of radiation. 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. Pdf repair of a wide lower extremity defect with cross. The gracilis muscle is located in the inner aspect of the thigh. The cross leg flap is a safe and reliable alternative to free tissue transfer in certain situations of lowerlimb trauma. Pdf salvage of severely mutilated lower limb using cross. The important technical considerations are outlined. Crossleg as salvage procedure after free flaps transfer failure. Versatility of a crossleg free rectus abdominis flap for. Pedicled cross extremity 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. 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. 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. Free style puzzle flap as a cross leg pedicled flap.
Repair of bilateral lower limb injuries using a free latissimus dorsi cross leg 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. Salvage of the lower extremity free flap using cross leg. Medical billing and coding procedure code, icd code. Lower extremity limb salvage with cross leg pedicle flap. Use of local muscle flaps to cover leg bone exposures.
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. In these conditions, the cross leg flap could be a good choice for reconstructing the defects. The pitfalls, however, have not been well documented in the literature. 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 fasciocutaneous flaps are less frequently indicated for distal leg and foot. Pdf repair of a wide lower extremity defect with crossleg. 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. Here we describe a case in which free flap reconstruction had to.
Successful detachment of crossleg fasciocutaneous flaps on the. Like most of the proven procedures, cross leg flaps. Reconstruction of the lower extremity with crossleg free. A block of tissue with its own blood vessels flap is removed from the thigh and transpl.
The cross leg flap and local fasciocutaneous flaps were most valuable for defects of the lower leg or foot, otherwise, a free flap would have been necessary. 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. All patients were hospitalized during this period and received acetylsalicylic acid 100 mgday. Reconstruction with cross leg free flaps ozkan et al. Crossleg free flap for limb salvage in the setting of. Original article distal perforator based cross leg flaps. Reconstruction of the lower extremity with crossleg free flaps. For flap revascularization, endtoend anastomosis in crossleg free flap procedure has some advantages, but it requires the elimination of one major artery of the. Cross leg flaps are a good choice for reconstructing traumatized lower extremities, especially when free flaps cannot be used. Review of crossleg flaps in reconstruction of posttraumatic. An alternative method to free flap for distal leg and foot. Limb salvage in an irradiated patient with limited recipient vessels leaves few options for reconstruction. The technique of transfer and the length of time required before pedicle division depend on the nature of the flap and the contact surface.
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. Twentyseven crossleg free flap transfers were performed. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using cross leg flaps. In order to reconstruct very extensive defects, the free cross leg flap and the free cable bridge flap have been described. Revisiting the fasciocutaneous perforator crossleg flap. When compared with the conventional cross leg flaps the discomfort, cross legging, joint stiffness and sore development are minimal. 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. Materials and methods the study data were collected between 2007 and 2015, from cases involving the use of cross leg free. Crossleg as salvage procedure after free flaps transfer.
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. Distal perforator based cross leg flaps for leg and foot defects. Buchan ac 1978 the place of the crossleg flap in reconstructive surgery of the lower leg and foot. The inclusion of fascia when raising a crossleg flap. The operative technique used was the standard approach so elegantly.
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