Cross-Leg Flap: Its Reliability and Outcome

Background: Cross-leg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. However, there are certain difficult situations where the free flap cannot be employed and alternative methods are needed. We describe our experience with cross-leg flap in 135 patients for the reconstruction of difficult leg defects in which no possible other options available for reconstruction of the defect. Materials and Methods: This study was carried upon one hundred thirty five patients suffering from leg and-or foot soft tissue injury. This study focused on the cases that need coverage of bone, tendons, and neurovascular bundle, while those that managed by local flap or split thickness graft were excluded. Results: All patients ambulate well after 5 - 10 days, except for 14 patients who had associated orthopedic problems as external fixation, or other fractures. Cosmetic outcome were excellent in all patients, but 3 patient’s mothers complaint of bulky flap, and for them liposuction was done with postoperative satisfaction. 2 cases complaint of early donnar sit graft, but later on they were satisfied. Conclusion: Cross-leg flap offers the possibil- ity of salvaging limbs that are otherwise nonreconstructable.

Free-style puzzle flap as a cross-leg pedicled flap: the concept of re-using a flap in acute burns, a case report

Background: In well-selected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. Case presentation: We report the case of a patient with full thickness burns on both legs, leading to the exposure of joints of the right ankle and the right foot and left patellar tendon. The right lower extremity was covered with a free musculo-cutaneous latissimus dorsi flap. Then, a musculo-cutaneous cross-leg flap pedicled on the anterior branch and centered on a perforator was harvested from the previous redundant flap to cover the controlateral knee. Conclusion: Sequential flap coverage can be considered in cases of extensive soft tissue defects and particularly in burns. This case illustrates that re-using a redundant part of a previous flap to cover another defect is a safe and interesting alternative in the event of a lack of donor sites or to save donor sites for later reconstruction of contracted burn scars.

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

In the recent decades,microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome.This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation.In the upper extremity,it is important to restore fine motility,together with allowing prompt mobilization.In the lower limb,care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing.Local perforator flaps can be considered for medium size defects.They provide thin coverage and can be performed in short operating time.Their use,though,is often limited by tissue availability.Free flaps allow to overcome this problem and,thanks to the recent development in the study of perforator vessels,the microsurgeon can choose the flap with the most appropriate characteristics.Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction.When dealing with limb preservation it is very important to consider residual functionality.Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases.A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps.In conclusion,extremity reconstruction and limb preservation are reaching new heights thanks,not only to the work of plastic surgeons,but also to the new developments in other fields of study such as oncology,traumatology,radiology and medical engineering.