Posterior Tibial Artery Cross-Leg Perforator Flap

Abstract

Lower extremity traumatic injuries with exposed vessels mandate prompt repair. Here the authors present a traumatic case in which a contralateral "septocutaneous tibialis posterior artery perforator"-based cross-leg flap was used to cover an open wound.

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

“…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][56][57][58][59][60][61][62] Prior free flap failure was cited as the indication for cross-leg flap in six publications (n ¼ 27 of 250, 10.8% of patients). 12,39,49,56,63,64 Comorbidities prohibiting free tissue transfer (n ¼ 19 of 250, 7.6% of patients), 12,…”

“…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.…”

“…Overall flap success rates, when commented on, were 100%, as even with the complications listed below, only 1 of the 350 flaps in which outcome was known failed completely. 33 Several publications did not specifically mention lack of complications, 16,21,23,24,[27][28][29]35,45,53 while the true rates for complications are not known, complication rate among the 46 studies (n ¼ 350) that reported complications was 21.1%. The only publications where limb salvage did not occur were Thomas et al, 58 which was a fillet flap used to cover an amputation stump, and the patient went on to become ambulatory with a prosthetic, and Fujimura et al, 13 but the paraplegic patient needed to have one leg amputated, and the other was saved.…”