Distally Based Extended Peroneal Artery Septocutaneous Perforator Cross-Bridge Flap without Microvascular Anastomoses for Reconstruction of Contralateral Leg and Foot Soft Tissue Defects

Abstract

A cross-leg or cross-bridge free flap is one of the choices for the reconstruction of serious leg soft tissue defects. Here, we report on six cases of leg and foot reconstruction with a distally based extended peroneal artery septocutaneous perforator cross-bridge flap without microvascular anastomoses. The vascular pedicle includes the peroneal artery, its perforator branch, and concomitant veins. The total pedicle length ranges from 10 to 14 cm, and the size ranges from 18 x 8 to 21 x 10 cm. All flaps survived completely without complications. Compared with a cross-leg or cross-bridge free flap, a distally based extended peroneal artery septocutaneous perforator cross-bridge flap without microvascular anastomoses does not require the use of some instruments or techniques for microsurgery, leading to a shorter operation duration and a lower risk of thrombosis in the vessel because microvascular anastomosis is not required.

Skin vascularisation field by the ascending branch of the peroneal artery ramus perforans

“…Our investigation confirmed that in the early 2010, Li et al 23 used this flap for reconstruction of knee defects with microvascular anastomosis.…”

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

“…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]…”

“…The majority of publications named the axial blood supply to the flaps described, though in 18 studies, 6,15,17,23,24,[27][28][29][33][34][35]37,45,46,50,52,55,60,63 the blood supply was unknown since it was not named, was described as random (used to describe as many as 136 patients) or was not easily inferred. Of those publications that did name an axial blood supply and made the number of patients with a given axial supply clear, the most common were the posterior tibial artery 25,36,38,42,43,48,53,[56][57][58]66 (11 of 37 publications, n ¼ 50 of 182, 27.5%) and peroneal artery 18,21,31,40,41,51,61,65 (8 of 37 publications, n ¼ 49 of 182, 26.9%) (►Fig. 4).…”

“…19 publications). 6,11,19,24,31,32,36,38,40-42,51,53,54,57 59,61-63 External fixators were the immobilization method used in 57.7% of cases (26 publications, n ¼ 184 of 319) of the cases, 6,12,15,20,22,[26][27][28]30,31,37,39,40,43,[46][47][48][49]52,54,55,57,60,61,63,64 with plaster cast 11,14,18,32,36,38,42,44,50,53,65 (33.2%, 11 publications, n ¼ 106 of 319), or other immobilization method being much less frequent. Pedicles were typically divided at 3 weeks (mean 20.9 days, range: 11-42 days).…”

“…Pedicles were typically divided at 3 weeks (mean 20.9 days, range: 11-42 days). Skin grafts were used to close the donor site 86.7% of the time (n ¼ 242 of 279, 32 publications) 6,11,[13][14][15]21,22,25,26,28,[30][31][32][33][34]36,38,40,[43][44][45][46][47][48][49][50][51]53,54,59,62,63 with primary closure less common (13.3%, n ¼ 37 of 279, 6 publications), 18,23,25,39,40,53 when the donor site closure was discussed.…”