Reconstruction of Lower Extremity Soft Tissue Defect using Cross-leg Free Flap

PURPOSE: To reconstruct soft tissue defect on lower extremity especially combined with osteomyelitis, free flap with enough blood supplies is required. There are some instance when patients have inadequate recipient vessels for microanastomosis. Anastomosis with harvested vein graft can solve the problem. It may be more problematic or even increase recipient site complication. Cross leg free flaps using contra-lateral vessel can be a solution. METHODS: From 2005 to 2008, 12 cases of cross leg free flap were done for 12 patients(9 male, 3 female). External fixators used in all cases. The free flaps used were laissmus dorsi muscle flap(n=5), anterolateral thigh flap(n=4), gracilis muscle flap(n=2) and medial plantar artery fasciotaneous flap(n=1). In all cases, contralateral posterior tibial artery and vein were used as recipient pedicle. RESULTS: All flaps survived without additional operative procedures. There happened no complications such as hematoma or Infection. Sometimes patients needed further therapeutic exercise for fast movement recovery. CONCLUSION: Although cross leg free flaps require long period of bed resting and rehabilitation after pedicle cutting, It can be a practical alternative for soft tissue defect on lower distal extremity with inadequate recipient vessels for free flap on affected leg.

Cross Leg Free Flap for the Reconstruction of Defects in Replanted or Revascularized Lower Extremities / 대한정형외과학회잡지

PURPOSE: This study was designed to evaluate the benefits of the cross leg free flap for the hereconstruction of soft tissue defects in replanted or revascularized lower extremities. MATERIALS AND METHODS: From 1992 to 1999, six cross leg free flap procedures were performed using the latissimus dorsi muscle for the reconstruction of soft tissue defects in patients with a vascularly compromised lower limb after replantation or revascularization. Four male and two female patients were included in this study, and the average age of these patients was 34 years (from 22 to 56 years). This procedure was applied to four patients for soft tissue defects in the lower leg, and in two for foot reconstruction. RESULTS: All of the flaps survived after pedicle division. The average period of immobilization was 32 days (from 23 to 43 days). There were minor complications, such as joint stiffness, partial loss of skin graft and hematoma formation. CONCLUSION: The cross leg free flap provides the possibility for the reconstruction of complicated and unfavorable cases, otherwise considered, unreconstructable. The indication for this procedure is extensive soft tissue defect with lack of adequate recipient vessels, especially in patients after replantation or revascularization.