Cross-Leg Flaps: Our Preferred Alternative to Free Flaps in the Treatment of Complex Traumatic Lower Extremity Wounds

Lu, Lixuan; Liu, Antang; Zhu, Lingling; Zhang, Jie; Zhu, Xiaodong; Jiang, Hua

doi:10.1016/j.jamcollsurg.2013.03.029

Cited by 35 publications

(50 citation statements)

References 27 publications

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“…[13,14,16,18] Since cross-leg flaps were introduced by Hamilton in 1854, a lot of techniques have been developed and introduced. [18,28,29] DBSF also can be used as cross-leg fashion due to its reliable pedicle length.…”

Section: Discussionmentioning

confidence: 99%

“…Lu et al [16] and Atiyeh et al [18] have concluded that cross-leg flaps are less technically demanding and the probability of reexploration is lower than in free flaps. Chen et al [5] showed that among 1142 free flap procedure, 113 (9.9%) of them had to be reexplored.…”

Section: Discussionmentioning

confidence: 99%

“…In this instance, the problem can be overcomed by using cross-leg flaps. [13][14][15][16] Additionally, after a free flap failure, cross-leg flaps can help repair any remaining defects. [17] One of the most useful alternatives to free tissue transfers in the lower leg is the cross-leg distally based sural flap (DBSF).…”

mentioning

confidence: 99%

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An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

Eser

Kesiktaş

Gencel

et al. 2015

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: High voltage electrical injuries can cause devastating results especially in distal extremities. Although free flaps are the golden standards for the reconstruction of these defects, sometimes local flap alternatives are more useful. One of the most favorable local flap is distally based sural flap (DBSF), which can be used in cross-leg fashion when ipsilateral extremity is affected by a high voltage electrical injury. The purpose of this study was to evaluate long term results of eleven patients who underwent a reconstruction to the lower extremity with cross-leg DBSF due to high voltage electrical burn injury between the years of 2003-2013.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

Eser

Kesiktaş

Gencel

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Ardından özellikle İkinci Dünya savaşı ve sonrasında yumuşak doku rekonstrüksiyonunda geniş bir şekilde yerini almıştır (3)(4)(5). Pediküllü çapraz bacak fl ebi mikrocerrahi gerektirmeyen, kolay, hızlı, çoğu zaman güvenilir, çok tecrü-be gerektirmeyen bir cerrahi yöntem olmakla beraber bazı durumlarda ekstremite kurtarıcı bir yöntem olarak kullanı-labilmektedir (1,3,16 Kliniğimizde eksternal fi ksatör ile fi ksasyon uygulanan hastaların büyük bir çoğunluğunda doku defekti olan ekstremitede kemik kırıkları için eksternal fi ksatör mevcuttu. Bundan dolayı kısa süreli ek bir cerrahi işlem ile karşı bacağa 2 adet pin vidası ile sistem kurulabilmektedir.…”

Section: Discussionunclassified

“…Bu immobilizasyon aşama-sında fl ep vaskülarize olmakta, ekstremiteler 2 ile 4 hafta arasında karşı bacaktan yeniden vaskülerize olduktan sonra birbirinden ayrılmaktadır. Bu süreç, diyabetik veya sigara kullanan hastalarda ve kas fl ebi uygulanan hastalarda daha uzun tutulabilmektedir (1,13). Bu nedenle özellikte operasyonların erken evresinde ciddi bir immobilizasyon olması gerekmektedir.…”

Section: Gereç Ve Yöntemlerunclassified

Alt Ekstremite Rekonstrüksiyonunda Kullanılan Çapraz Bacak Fleplerinde Fiksasyon Yöntemlerinin Karşılaştırılması

Özkan¹,

Bektas²,

Cinpolat³

et al. 2015

Akd Med J

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ÖZAmaç: Alt ekstremite geniş doku defektlerinin rekonstrüksiyonu zorlu bir süreçtir. Rekonstrüksiyon seçeneklerinden biri çapraz bacak fl epleridir. Çapraz bacak fl ebi operasyonlarında her iki alt ekstremitenin immobilize edilmesi gerekmektedir. Makalemizde kliniğimizde yapmış olduğumuz pediküllü ve serbest çapraz bacak fl eplerinde immobilizasyon yöntemleri ile ilgili tecrübelerimizi sunmaktayız. Gereç ve Yöntemler: 2007-2015 yılları arasında toplam 37 hastaya (6 kadın, 31 erkek), çapraz bacak fl ebi uygulandı. Hastaların ortalama yaşı 33'tü. (6-76 arası). 27 hastaya serbest çapraz bacak fl ebi uygulandı, 10 hastaya pediküllü çapraz bacak fl ebi uygulandı. 22 serbest, 3 pediküllü çapraz bacak fl ebi uygulanan toplam 25 hastaya eksternal fi ksatör ile fi ksasyon yapıldı. 5 serbest, 6 pediküllü çapraz bacak fl ebi uygulanan toplam 11 hastaya geleneksel alçı ile fi ksasyon uygulandı. Pediküllü çapraz bacak fl ebi yapılan 1 hastaya ise 3 adet steinmann çivisi ile fi ksasyon uygulandı. Bulgular: Serbest fl ep uygulanan hastaların 3 tanesinde, pediküllü fl ep yapılan hastalardan 2 tanesinde parsiyel fl ep kayıbı gözlenmiş olup yara debritmanı ve pansumanlarla tam iyileşme sağlanmıştır. Eksternal fi ksatör kullanılan hastaların 2 tanesinde topukta grade 2 bası yarası, 2 hastada ise grade 3 bası yarası görülmüş olup alçı kullanılan hastaların hepsinde ekstremitede hiperemi ve büllöz yaralar gözlenmiştir. Hiçbir hastada sinir, damar yaralanması, gözlenmemiş olup, alçı uygulanan hastalarda minimal eklem kontraktürü gözlenmiştir. Sonuç: Çapraz bacak fl eplerinde, immobilizasyon yöntemi olarak eksternal fi ksatör kullanımının fl ep başarısında, hasta bakım ve konforunda daha başarılı olduğunu savunmaktayız. Anahtar Sözcükler: Çapraz bacak fl ebi, Alt ekstremite rekonstrüksiyonu, Eksternal fi ksatör ABSTRACT Objective: Reconstruction of traumatic soft tissue defects of the lower limb is usually challenging. One of the reconstruction options is cross-leg fl aps. Both lower extremities must be immobilized in cross-leg fl ap surgery. In this article, we present our clinical experience with immobilization of the lower extremities during pedicled or free cross-leg fl ap surgery. Material and Methods: A total of 37 patients consisting of 6 females and 31 males underwent cross-leg surgery between 2007 and 2015. The mean age was 33 (range 6 to 76) years. We had 27 patients undergo free cross-leg surgery and 10 patients were treated with pedicled cross-leg fl aps. 25 patients (22 free and 3 pedicled) were immobilized with external fi xators while 11 patients (5 free and 6 pedicled cross-leg patients) were immobilized with a plaster cast. 1 pedicled cross-leg patient was immobilized with 3 Steinmann pins. Results: Partial necrosis occurred in 3 free cross-leg patients, and 2 pedicled cross-leg patients. Grade 2 pressure sores developed in 2 patients and grade 3 pressure sores developed in 2 patients immobilized with an external fi xator but healed completely with debridement and wound management. All plaster cast patients had hypere...

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The cross‐leg free flap: A systematic review of the literature

Celie,

Guo,

Raya

et al. 2024

Microsurgery

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BackgroundFree tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross‐leg flap cannot provide enough coverage, a cross‐leg free flap (CLFF) is a limb‐saving alternative. The aim of this study is to conduct a systematic review of the literature published on the CLFF.MethodsWe conducted a systematic review of articles describing the CLFF, according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Inclusion criteria included articles with primary data on the CLFF. Exclusion criteria included those describing pedicled cross‐leg flaps or lacking complete data. Data analysis was performed using SPSS 29.0.ResultsOur review included 28 articles encompassing 130 patients who underwent free tissue transfer. Most were male (63.8%) with a mean age of 32.4 years. Latissimus dorsi was the most common flap type (30.0%), followed by vertical rectus myocutaneous (20.0%). Average flap size was 301.8 cm2, with trauma in the lower third of the leg being the most common indication (73.1%). The contralateral posterior tibialis was the most common recipient artery (84.1%) followed by the anterior tibialis (9.5%). Complications included amputation (1.4%), partial graft loss, thrombosis, hematoma, prolonged pain, nonunion, and seroma; a forest plot was used to illustrate the low overall adverse events rate. Although bivariate analysis identified age, flap size, type, location, and donor site as variables significantly impacting the incidence of complications (p < .05), this was not sustained in a multivariate logistic regression model.ConclusionThe CLFF remains an excellent option for limb salvage when a suitable recipient vessel is unavailable. Our review demonstrates 1.4% flap failure and an acceptable complication rate. While most cases in our review describe muscle flaps, we report a complex case of limb salvage using an unusually large anterolateral thigh flap.

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Cross-Leg Flaps: Our Preferred Alternative to Free Flaps in the Treatment of Complex Traumatic Lower Extremity Wounds

Cited by 35 publications

References 27 publications

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

An alternative method to free flap for distal leg and foot defects due to electrical burn injury: Distally Based Cross-Leg Sural Flap

Alt Ekstremite Rekonstrüksiyonunda Kullanılan Çapraz Bacak Fleplerinde Fiksasyon Yöntemlerinin Karşılaştırılması

The cross‐leg free flap: A systematic review of the literature

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