Repair of Pretibial Atonic Wound With Long Cross-Leg Flap

Abstract

Soft-tissue defects of the pretibial region constitute a major reconstructive challenge because of the insufficiency of the local tissues. In such cases, a long cross-leg flap may be an alternative option. This study presents a case with an atonic wound in the pretibial region caused by a previous traffic accident, which had received cross-leg flap repair following the excision.

La fijación externa en cirugía reconstructiva: colgajo de piernas cruzadas.

“…Sin embargo, en casos en que por el traumatismo sufrido por la extremidad inferior no se dispone de vasos para realizar una anastomosis satisfactoria, el colgajo de piernas cruzadas es una alternativa que ha demostrado buenos resultados. El colgajo de piernas cruzadas ha sido utilizado con éxito en defectos de cobertura en zona pretibial (2) , zona en que debido a la precaria vascularización cutánea es frecuente encontrar fracaso de partes blandas. Esta técnica ha demostrado buenos resultados en el tratamiento de defectos de cobertura asociados a traumatismos graves, como fracturas de pilón tibial de alta energía (3) o tras sufrir accidentes de tráfico (4) , definiéndose por algunos autores como la alternativa preferida a los colgajos libres en el tratamiento de defectos de partes blandas postraumáticos del miembro inferior (5,6) .…”

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]…”

“…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,…”

“…Various names were used to describe flaps, as there was not a consistent nomenclature. Fasciocutaneous was the most common broad classification, mentioned in 31 publications 6,11,12,[15][16][17][18][20][21][22]25,28,30,[32][33][34][36][37][38][42][43][44][45][46]49,50,56,57,59,63,65 including 273 patients (n ¼ 273 of 318, 85.8%), with muscle or myocutaneous second most common, 20,29,30,37,39,44,47 including 45 patients (n ¼ 45 of 318, 14.2%). Other flap types were not described according to common nomenclature, and it was impossible to tell if they were fasciocutaneous or musculocutaneous (n ¼ 83).…”

“…Other flap types were not described according to common nomenclature, and it was impossible to tell if they were fasciocutaneous or musculocutaneous (n ¼ 83). 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.…”