Repair of Severe Composite Tissue Defects in the Lower Leg Using Two Different Cross-Leg Free Composite Tissue Flaps

Li, Yu; Tan, Jun; Cai, Lin; Yu, Guangrong; Tao, Shengxiang; Wei, RenXiong; Chen, Zhenguang

doi:10.1097/sap.0b013e3181fe9351

Cited by 14 publications

(23 citation statements)

References 16 publications

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“…Since World War II, a valuable option in these cases have been represented by cross-leg flaps, giving the possibility of transferring contralateral healthy tissue to the injured lower limb [117,118] . The use of this technique has continued over time, with different cross-leg flaps reported, and satisfying outcomes [119][120][121] . Advances in microsurgical techniques have enhanced direct reconstruction but, some of the new concepts, such as free flaps and flow-through flaps, can be applied also to cross-leg flaps.…”

Section: Devascularized Limbsmentioning

confidence: 99%

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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In the recent decades, microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic outcome. This review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb preservation. In the upper extremity, it is important to restore fine motility, together with allowing prompt mobilization. In the lower limb, care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe wearing. Local perforator flaps can be considered for medium size defects. They provide thin coverage and can be performed in short operating time. Their use, though, is often limited by tissue availability. Free flaps allow to overcome this problem and, thanks to the recent development in the study of perforator vessels, the microsurgeon can choose the flap with the most appropriate characteristics. Chimeric flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone reconstruction. When dealing with limb preservation it is very important to consider residual functionality. Functioning muscle transfer and targeted muscle re-innervation can be performed in these cases. A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free flaps. In conclusion, extremity reconstruction and limb preservation are reaching new heights thanks, not only to the work of plastic surgeons, but also to the new developments in other fields of study such as oncology, traumatology, radiology and medical engineering.

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Section: Devascularized Limbsmentioning

confidence: 99%

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Bolletta¹,

Rubino²,

Chen³

2019

PAR

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“…A suitable flap should therefore be selected for reconstruction based on the patient's condition. 12 We applied various different types of free flaps for reconstruction, such as the LD myocutaneous flap, ALT flap, TFL flap, gracilis flap, DIEP flap and, VL myocutaneous flap as examples of cross-leg free flaps. Our series therefore supports this theory.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15] The purpose of this study is to describe our experience with the cross-leg free flap in 27 patients for the reconstruction of severely damaged lower extremities with no suitable adjacent recipient vessels available for microvascular anastomosis.…”

Section: Introductionmentioning

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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“…The case of a 17-year-old boy following the fracture of both tibia and fibula, subsequent compartment syndrome, and fasciotomy. A -completely exposed tibia and its internal fixation, Bafter transferring the cross-leg flap, C -the donor site covered with a free partial-thickness skin graft, D -end result 2) good esthetic results, 3) no need for unnatural immobilization, 4) capability of being used as a rotated, perforator-based local flap, or a free one to cover distal defects, 5) capability of being used in pediatric patients (36)(37)(38)(39)(40).…”

Section: Discussionmentioning

confidence: 99%

Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

Elsaftawy¹,

Jabłecki²,

Domanasiewicz³

et al. 2013

Polish Journal of Surgery

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Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. the aim of the study was to present the results of treating lower extremity defects with various modifications of the reverse sural flap. material and methods. Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. results. All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partialthickness skin graft. conclusions. The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps.

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Repair of Severe Composite Tissue Defects in the Lower Leg Using Two Different Cross-Leg Free Composite Tissue Flaps

Cited by 14 publications

References 16 publications

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Reconstruction of the Lower Extremity with Cross-Leg Free Flaps

Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

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