The Cross-Leg Gastrocnemius Muscle Flap for Leg Reconstruction of the Difficult and Unfavorable Conditions

ABSTRACT

PURPOSE: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross-leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross-leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross-leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. METHODS: Twelve patients(9 males and 3 females) underwent the operation from October 2001 to December 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross-leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed in 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days(3 to 6 weeks). Mean follow-up period was 4 years. RESULTS: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional or cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches in 3 months postoperatively. CONCLUSION: Although pedicled cross-leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.