Cross-leg repair of large soft-tissue defects in distal sites of the feet by distally based neuro-fasciocutaneous flaps with perforating vessels

Abstract

ABSTRACT. The objective of this study was to introduce a method for repairing large soft-tissue defects on the foot. Distally based neurofasciocutaneous flaps with perforating vessels were designed along the saphenous and sural neurovascular axes. The cutaneous perforating branches of the major arteries of the lower extremities were used as pedicles, which provided a rotation arc for the cross-leg flap to cover the large-sized soft-tissue defects on the foot. We transferred 6 neurocutaneous vascular axial flaps, including 4 saphenous neurocutaneous axial flaps (ranging from 25 x 13 to 17 x 9 cm in area) with posterior tibial perforators as the pedicle, and 2 sural neurocutaneous axial flaps (ranging from 29 x 12 to 18 x 7 cm in area) supplied by the perforating branches of the peroneal vessels. These 6 cases of neuro-fasciocutaneous flaps survived with satisfactory cosmetic appearances and functional results on follow-up at 8 to 17 months post-surgery. Placing a distally based neurofasciocutaneous cross-leg flap with perforating vessels is an effective method for repairing large-sized soft-tissue defects on the foot.

La fijación externa en cirugía reconstructiva: colgajo de piernas cruzadas

“…Algunos autores publican resultados satisfactorios en defectos en extremidades inferiores en niños, siendo una buena alternativa al tratamiento debido a la dificultad de realizar colgajos microvascularizados en pacientes pediátricos por el pequeño calibre de los vasos y por las lesiones de los mismos tras haber sufrido traumatismos importantes (9). También esta técnica se ha usado para realizar colgajos neurofasciocutáneos en lesiones en pies con buen resultado estético y funcional a medio-largo plazo (10) , siendo satisfactorio tanto respecto a la deambulación como a la recuperación de la sensibilidad cutánea.…”

Cross-Leg Flaps for Lower Extremity Salvage: A Scoping Review

“…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).…”

“…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.…”

“…Pedicles were typically divided at 3 weeks (mean 20.9 days, range: 11-42 days). Skin grafts were used to close the donor site 86.7% of the time (n ¼ 242 of 279, 32 publications) 6,11,[13][14][15]21,22,25,26,28,[30][31][32][33][34]36,38,40,[43][44][45][46][47][48][49][50][51]53,54,59,62,63 with primary closure less common (13.3%, n ¼ 37 of 279, 6 publications), 18,23,25,39,40,53 when the donor site closure was discussed.…”