A convenient flap for repairing the donor area of a distally based sural flap: Gastrocnemius perforator island flap

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,…”

“…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).…”

“…Typically, lower extremity cross-leg flaps were used to cover the middle (n ¼ 36 of 272, 13.2%) and distal third of the leg (n ¼ 151 of 272, 55.5%), or the foot (n ¼ 76 of 272, 27.9%). Size of defect was mentioned in 13 publications, 12,15,25,26,30,41,[45][46][47][48]51,57,59,63 including 142 patients, with a wide range of 12 to 360 cm 2 . Wound VAC preparation was mentioned as the wound prep method in five publications 12,26,52,57,63 including a minimum of eight patients, with debridement as the wound prep method mentioned in 21 publications 13,14,22,26-28,30 36,39,41,44-46,51,53,55,58-60,64,65 Fig.…”

“…The next most common complications were infection (n ¼ 10 of 350, 2.9%), osteomyelitis (n ¼ 7 of 350, 2.0%), skin graft loss at either the flap or donor site (n ¼ 4 of 350, 1.1%), venous congestion (n ¼ 2 of 350, 0.6%) and ulceration, shearing, deep vein thrombosis (DVT), and hypertrophic scar mentioned in one case each. 6,12,14,17,18,20,25,[30][31][32]34,[37][38][39][40][41][42][43]52,[58][59][60]64 Two-third of publications commented on mobility or ambulatory status, with ability to ambulate (n ¼ 240 patients, 29 publications) 6,12,16,18,19,22,23,26,29,31,36,37,39,[41][42][43][44]46,52,[55][56][57][58][59][60]…”