Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity Reconstruction

Abstract

When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

Modified Recipient Blood Flow-preserved Cross-leg Anterolateral Thigh Flap Procedure for Complex Lower Extremity Reconstruction

“…Adequate diameter and blood ow of the posterior tibial vascular system contribute to the survival of the ap. In 2020, Bali et al conducted a study of 12 patients who underwent recipient blood ow-preserved cross-leg free ap procedures [12]. In Bali's study, an anterolateral thigh fasciocutaneous ap was used in 8 patients for reconstruction of small or medium defects, while a latissimus dorsi ap was used in 4 patients with large defects.…”

“…Thus, the blood ow of recipient posterior tibial artery was reestablished in the rst stage of anterolateral thigh ap procedure ( ow-through technique), while in the second stage of latissimus dorsi ap procedure (rerouting technique). To our knowledge, there are only a few studies of ow-through pedicled cross-leg free ap procedures for lower limb reconstruction in previous literature, all of which involve fewer cases [11,12,29,[31][32][33][34]. Among these studies, the aps are chosen based on the size and shape of the tissue defect.…”

“…Our study suggests that various defects ranging from 72 to 378 cm 2 could be effectively covered by relevant-sized anterolateral thigh aps. On the other hand, compared with ap coverage, skin wrapping is more convenient for postoperative blood ow observation and dressing change, and is much easier for pedicle division in the second-stage procedure [12]. The free skin wrapping technique has been reported previously [35].…”

“…The main disadvantage of this procedure is that the blood supply to distal lower limb is obviously reduced. Currently, a cross-leg ow-through pedicled free ap procedure is established, which preserves the integrality of recipient vessels and blood circulation in healthy lower limb [11][12][13]. In this promising procedure, the donor artery is prepared as a reverse Y-shaped fashion and further inserted to the recipient artery by anastomosing the Y-shaped arterial branches to the two transected ends of the recipient artery.…”

Autumn Issue With Gathering Swallows in the Skies

“…This holds especially true for health care professionals wishing to increase public awareness. 10 In a surgical viewpoint, Bali et al 11 emphasize the continuity of the recipient artery and its importance for cross-leg free flaps. Ozturk et al 12 analyze coldness, ecchymosis, and related symptoms among subjects with peripheral varicose veins.…”