Preserving the blood flow of the recipient artery in cross. The pitfalls, however, have not been well documented in the literature. Good local tissue coverage was not available and free tissue transfer. The records of all patients who had cross leg flap for trauma in the last 2. 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.
The lateral intermuscular septum separates the lateral compartment muscles from the soleus. The technique of muscle transposition in the operative treatment of traumatic and ulcerative lesions of the leg. Reconstruction of the lower extremity with crossleg free flaps. Surgical technique the posterior tibial vessels of the contralateral leg were prepared as recipient vessels for all patients. When harvesting the osteocutaneous flap, the septum is harvested in continuity with the paddle of skin and fascia of the lateral leg. Crossleg as salvage procedure after free flaps transfer. Eight cross leg free flap reconstructions were performed. Buchan ac 1978 the place of the crossleg flap in reconstructive surgery of the lower leg and foot. The cross leg flap is a safer, less complicated technique that allows for better matching of skin color, texture, and thickness, reduced operative time, and less donor site morbidity than distal free flaps. Background crossleg 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.
Among the methods for reconstructing defects of the lower extremities, there are direct closure, skin grafting, and local flaps including the muscle flap, crossleg flap and free flap. Surgeons have long sought an alternative to the crossleg flap. Both patients showed a satisfactory recovery returning to walk without additional help. An alternative method to free flap for distal leg and foot. Repair of bilateral lower limb injuries using a free latissimus dorsi crossleg flap. However, the crossleg flap remains an effective alternative in situations that require an alternative to free tissue transfer. Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. The purpose of this report is to introduce the cross. Distal perforator based cross leg flaps for leg and foot defects. The design and harvest of combined flap consisted of anterolateral thigh perforator flap and thoracic umbilical flap a. Crossleg as salvage procedure after free flaps transfer failure.
Use of a crossleg free muscle flap to reconstruct an extensive burn wound involving a lower extremity. When compared with the conventional cross leg flaps the discomfort, cross legging, joint stiffness and sore development are minimal. Free flap reconstruction following lower leg trauma in the. Moreover, a cross leg flap does not require microsurgical capabilities and can be performed with basic equipment. It is suggested as an alternative method to a difficult cross. Reconstruction of the lower extremity with cross leg free flaps ozlenen ozkan, md1 an. The primary goal in limb salvage is definite wound closure by using appropriate flaps. The use of external fixator for immobilization circumvents many of these problems and facilitates the use of cross leg flaps in patients in whom free tissue transfer may not be optimal. 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. Cross leg free muscle flaps of large volume such as the. A new and safer anastomosis technique in crossleg free flap procedure using the dorsalis pedis arterial system. In wellselected cases, flaps can play a pivotal role in optimizing outcomes in the acute phase of burns. Evolution of local perforator flaps in lower extremity.
However, the situation occasionally arises in which an alternative method may be. All three defects were covered with a medially based narrow pedicled triangular cross leg flap based on 23 adjacent posterior tibial perforators about 12 cm from the medial border of the tibia in its middle. Repair of a wide lower extremity defect with crossleg. A new and safer anastomosis technique in crossleg free. The traditional crossleg reconstruction used a random patterned flap with a wide base, making the flap.
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. Standard cross leg flap, still a work horse for compound. We describe our experience with crossleg flap in 5 patients for the reconstruction of difficult leg defects in which no possible other. All patients had satisfactory and stable reconstruction. The crossleg flap became widely popular during world war ii as a limb salvage technique to treat injuries sustained in battle. When a free flap is contraindicated or after a free flap failure, the crossleg flap is still nowadays a possible option. Because the crossleg flap, which is located in a lower rung of the reconstructive ladder, is less technically demanding, demonstrates greater safety, and could provide different types of tissue for repairing complex defects, we prefer to use the crossleg flap first instead of a free flap for reconstruction of traumatic lower extremities when local flaps are not available. Crossleg flaps are a good choice for reconstructing traumatized lower extremities, especially when free flaps cannot be used. The gracilis muscle is located in the inner aspect of the thigh. This is quite relevant because the highest percentage of failure of free flaps is encountered in cases of resurfacing the traumatic defects of the distal leg and foot. The crossleg free flap procedure was first described by taylor et al.
Stark1950 standardized the procedure and summarized its usefulness for lower extremities trauma. Standard cross leg flap, still a work horse for compound fracture leg bones with extensive soft tissue damage. A previous redundant flap could be reused or recycled as a donor site from which a new flap could be raised. A crossleg free rectus abdominis flap, anastomosing to utilized carrier vessels of the contralateral noninjured leg, was used for reconstruction in six cases of.
In this technique, the vascular pedicle of the free flap is temporarily anastomosed to the recipient vessels of the contralateral leg and then detached after obtaining sufficient revascularization of the flap. 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. Crossleg free flaps have been used to reconstruct defects that would otherwise lead to amputation in patients with no ipsilateral recipient vessels. Pdf repair of a wide lower extremity defect with cross. However, with the advent of microvascular surgery and the introduction of the free flap in 1970, use of the crossleg flap and other distant flaps declined. Noordhoff ms, tang y 1997 crossleg free flaps for difficult cases of legs defects.
The details of each case are summarized in table 1. The operative technique used was the standard approach so elegantly. Crossleg free muscle flaps of large volume such as the. Soft tissue coverage of distal leg and ankle region represents a challenge and such defect usually requires a free flap. Crossleg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage. Extension from the skin to the subcutaneous tissues occurs at times, and, although the infection usually is confined to the lower extremities, it may involve the hands and arms. The cross leg fasciocutaneous flaps are less frequently indicated for distal leg and foot. Because the crossleg flap, which is located in a lower rung of the reconstructive ladder fig. Table 1 demographics of three distinct cases describing the modified cross leg flap for large triangular defects of the foot and ankle. A cross leg flap was performed stabilizing both lower limbs with an external fixator. Versatility of a cross leg free rectus abdominis flap for leg reconstruction under difficult and unfavorable conditions.
Reconstruction of the lower extremity with crossleg free. Crossleg free flaps for difficult cases of leg defects. Pedicled crossleg flaps pedicled crossleg flaps halls, michael j. 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. We describe our experience with crossleg flap in 18 patients for the reconstruction of difficult leg defects in which no suitable recipient vessels were available for microvascular. In order to reconstruct very extensive defects, the free cross leg flap and the free cable bridge flap have been described. Crossleg repair of large softtissue defects in distal. We present the first documented case of a crossleg free flap for limb salvage in a radiated bed after infection and. Twelve cases of such ulcers were covered with medial plantar vascular pedicled flaps and the results had been excellent. With the introduction of perforator flap, management of small and mediumsize defects of distal leg and ankle region is convenient. Original article distal perforator based cross leg flaps. In crosssection, the interosseous membrane is seen in green, spanning from the tibia to the fibula. An alternative method to free flap for distal leg and foot defects due to electrical burn injury.
Chromoblastomycosis is a chronic infectious disease of the skin characterized by nodular, verrucous, or cauliflowerlike lesions. Large ulcers around the heel region are common but difficult problems because the usual methods of resurfacing are unsatisfactory. Since the crossleg flap was first described by ham ilton in 1874,1 it was the. Even when a free tissue transfer can be performed the risk of failure remains considerable. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. The crossleg flap technique is a wellestablished method to cover soft. In order to reconstruct very extensive defects, the free crossleg flap and the free cable bridge flap have been described. Use of the medial plantar flap in soft tissue replacement. Limb salvage in an irradiated patient with limited recipient vessels leaves few options for reconstruction. Crossleg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. Crossleg free flap for limb salvage in the setting of. Pedicled crossextremity flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades.
Cross leg flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. The versatility of perforatorbased propeller flap for. When a free flap is contraindicated or after a free flap failure, the crossleg flap is still nowadays a possible. Revisiting the fasciocutaneous perforator crossleg flap ncbi. Reconstruction of large defects can only be achieved with microsurgical procedures. However, this may lead to considerable donor site morbidity, is time consuming, and needs facility of microsurgery. Pedicled crossleg flaps, journal of the american college.
Even in tertiary care centers cross leg flaps is a viable procedure in failed free flap surgeries. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using crossleg flaps. A new and safer anastomosis technique in crossleg free flap procedure using the dorsalis pedis arterial system topalan, murat m. Transplantation treatment of extensive softtissue defects. Pdf repair of bilateral lower limb injuries using a free. Compared with a crossleg or crossbridge free flap, a distally based posterior tibial artery crossbridge flap is reliable and versatile, leading to shorter operation duration and a lower risk of. The cross leg free flap procedure was first described by taylor et al. Hence, medially based standard cross leg flap was planned for covering the exposed tibia. Cinpolat, md2 gamze bektas, md2 arzu akcal, md1 harun simsek, md1 polat bicici, md1 seckin ayd.
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