Cross leg posterior tibial artery fasciocutaneous island flap for reconstruction of lower leg defects

Sharma, Ramesh Kumar; Kola, G.

doi:10.1016/0007-1226(92)90119-i

Cited by 21 publications

(14 citation statements)

References 15 publications

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“…11 Various successful results have been published using the cross-leg method. [19][20][21][22][23][24][25][26][27][28][29][30] Yu et al published an 85-case series using the cross-bridge method and reported a success rate of 95.29%. 20 The advantages of reconstruction with cross-leg free flaps include the possibility of preparation with the required tissue components such as bone and muscle of the requisite sizes and allowing the anastomosis line to be completely outside the trauma zone.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Özkan

Cinpolat

Bektas

et al. 2016

J Reconstr Microsurg Open

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Background?The absence of suitable adjacent recipient vessels for microvascular anastomosis due to trauma poses a major challenge to the reconstructive surgeon. The anterior and posterior tibial vessels of the contralateral leg are the two other alternatives for use as recipient vessels for microvascular anastomosis. This method is known as the cross-leg free flap. Methods?Twenty-seven patients (20 males, 7 females) underwent cross-leg free flap operations due to absence of a suitable adjacent recipient vessel between 2007 and 2015. The mean soft tissue defect dimension was 12???11 cm (smallest: 6???7 cm; largest: 20 ?14 cm). Gustilo type 3B tibia fractures were present in 19 patients, but no fractures were present in the other 8. Six different flaps were used: 14 anterolateral thigh flaps, 6 latissimus dorsi flaps, 3 gracilis muscle flaps, 2 vastus lateralis musculocutaneous flaps, 1 tensor fascia latae flap, and 1 deep inferior epigastric perforator flap. Results?Two anterolateral thigh flaps failed, while the rest of the flaps survived completely. There were no donor-site complications. Conclusion?We think that the cross-leg free flap method can be safely and successfully used with all flap types in complex lower extremity injuries in which the adjacent recipient vessel option is unavailable.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Özkan

Cinpolat

Bektas

et al. 2016

J Reconstr Microsurg Open

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“…Patients must come for weekly injections averaging once a week for 3 months. [4][5][6][7][8][9][10][11] Problems with exposure, necrosis of adjacent tissue, and paresthesia from compression of peripheral nerves may occur. 4 Intraoperative expansion provides little improvement in the subfascial pocket.…”

Section: Discussionmentioning

confidence: 99%

Calf augmentation using free tram flap

et al. 1999

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Augmentation of the calf for correction of contour deformities has been most frequently performed utilizing silicone implants. Results of such implants have often been unsatisfactory. We report the case of a 27-year-old woman who chose the use of a transverse rectus abdominis myocutaneous (TRAM) free flap for correction of a left calf contour deformity from childhood polio. This is the first report of calf augmentation with the use of a TRAM free flap and excellent results were obtained.

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“…11,15,17,20,21,[33][34][35][36][37][38][39][40][41] The second most common reason cited as an indication to avoid free tissue transfer was the associated risk (12 of 56 publications, 107 of 322, 33.2% of patients). 14,21,32,37,[39][40][41][42][43][44][45][46] The third most common reason why free tissue transfer was not used was anatomic limitation (28 of 51 publications, n ¼ 170 of 322, 52.8% of patients) described in a variety of ways: no recipient vessels, inadequate vasculature, poor vascular supply, severe arterial injury, vascular damage, extensive zone of injury, lack of vasculature, one vessel run-off, or slight variations on the same language. 6,12,15,19,20,36,37,39,41,42,45,[47][48][49][50][51][52][53][54][55]…”

Section: Indications For Not Performing Free Tissue Transfermentioning

confidence: 99%

Cross-Leg Flaps for Lower Extremity Salvage: A Scoping Review

Boerum

Wright

McFarland

et al. 2019

J reconstr Microsurg

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Background Lower extremity trauma with soft tissue loss presents a challenge to the reconstructive surgeon. Cross-leg flaps, first described by Hamilton in 1854, are still used to salvage traumatized lower extremities in patients not suitable for free tissue transfer, or those who are receiving care in locations with limited resources. Methods A scoping review methodology was used to examine the evidence supporting the use of cross-leg flaps in modern healthcare. Results There have been 409 cases of cross-leg flaps reported in the modern literature, with the majority of flap cases occurring outside the United States in Turkey, India, and Japan. The most common indication was trauma, mentioned in 93.2% of patients (n = 353 of 379), and anatomic limitation, including inadequate vasculature, was the main reason for not performing free tissue transfer (52.8% of patients; n = 170 of 322). The majority are cross-leg fasciocutaneous flaps (85.8%, n = 273 of 318), based off the posterior tibial artery (27.5%, n = 50 of 182) and peroneal artery (26.9%, n = 49 of 182) and, covering defects of the distal third of the leg (55.5%, n = 151 of 272), or the foot (27.9%, n = 76 of 272). The pedicles are typically divided at 3 weeks (mean 20.9 days) after external fixation is used as the immobilization method (57.7%, n = 184 of 319). Flap survival was 100% across all publications except one (n = 349 of 350 patients), making cross-leg flaps a robust and reliable reconstructive option. Conclusion In resource-limited environments or in patients who are unsuitable for microvascular free tissue transfer, the cross-leg flap remains an impactful and reliable option for limb salvage.

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Cross leg posterior tibial artery fasciocutaneous island flap for reconstruction of lower leg defects

Cited by 21 publications

References 15 publications

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Calf augmentation using free tram flap

Cross-Leg Flaps for Lower Extremity Salvage: A Scoping Review

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