DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172502

Cross leg flaps: are they relevant in the present era?

Mahadevan K., Charan J. C., Sridevi S.

Abstract


Background: Injuries of lower limb due to road traffic accidents are challenging to reconstruct due to paucity of tissues and damage to vasculature. Recurrent trophic ulcers are also difficult to reconstruct due to stigmata of previous surgeries. When local and regional flaps are not available, free flaps become the best option. The success of free flap depends on the presence of healthy recipient vessels and microsurgical expertise. In cases where the free flaps have failed or when there is no available soft tissue for local flaps, cross leg flaps are a method of resurfacing and salvaging the limb.

Methods: This Study was done from January 2013 to January 2016 in Rajiv Gandhi Government General Hospital, Chennai. 20 patients were included in the study and the flaps used were conventional cross leg and cross leg reverse superficial sural artery flap.

Results: All flaps survived. There was one case of wound dehiscence managed by re-insetting, two cases with marginal necrosis which were managed conservatively. One case of partial loss which was managed by STSG and one case of sinus formation due to tuberculosis managed with ATT. Remaining flaps had no complications.

Conclusions: Cross leg flaps are still relevant in the present era of microsurgery. They can be the primary choice of reconstruction or as a workhorse when free flaps have failed or other loco regional flaps are already exhausted. Immobilisation and two stage reconstruction are few disadvantages which when weighed against limb salvage are acceptable. 


Keywords


Cross leg flap, Lower limb trauma, trophic ulcer, Limb salvage

Full Text:

PDF

References


Stark RB. The cross leg flap procedure. Plastic Reconstr Surg. 1952;9:173-204.

Devansh S. Prefabricated recipient vascular pedicle for free composite-tissue transfer in the chronic stage of severe leg trauma. Plast Reconstr Surg. 1995;96:392-9.

Yamada A, Harii K, Ueda K, Asota H, Tanaka H. Versatility of a cross leg free rectus abdominis flap for leg reconstruction under difficult and unfavorable conditions. Plast Reconstr Surg. 1995;95:1253-7.

Lai CS, Lin SD, Chou CK, Cheng YM. Use of a cross-leg free muscle flap to reconstruct an extensive burn wound involving a lower extremity. Burns 1991;17:510-3.

Chen H, El-Gammal TA, Wei F, Chen H, Noordhoff MS, Tang Y. Cross-leg free flaps for difficult cases of leg defects: Indications, pitfalls, and long-term results. Trauma. 1997;43:486-91.

Agarwal P, Raza HKT. Cross-leg flap: Its role in limb salvage. Indian J Orthop. 2008;42(4):439-43.

Wells MD, Bowen CV, Manktelow RT, Graham J, Boyd JB. Lower extremity free flaps: A review. Can J Surg. 1996;39:233-9.

Serafin D, Georgiade N, Smith DH. Comparison of free flaps with pedicled flaps for coverage of defects of the leg or foot. Plast Reconstr Surg. 1977;59:492-9.

Morris AM, Buchan AC. The place of the cross-leg flap in reconstructive surgery of the lower leg and foot: A review of 165 cases. Br J Plast Surg. 1978;31:138-42.

Bhattacharya V, Reddy GR. Distal perforator based cross leg flaps for leg and foot defects. Indian J Plast Surg. 2005;38:18-21.