Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report

Jin, Wenhu; Chang, Shusen; Zhang, Ziyang; Wu, Xiangkui; Wu, Bihua; Qi, Jianping; Wei, Zairong

doi:10.1080/08941939.2022.2058127

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Our systematic review of the literature shows that CLFFs have been used to treat a broad range of severe tissue defects when using recipient vessels was not feasible (Zhang et al, 2012a; Bali et al, 2020; Bishop et al, 2018; Cipriani et al, 1999; Ciudad et al, 2020; Gencel et al, 2016; Zhang et al, 2012b; Hamdi et al, 2000; Hodgkinson et al, 1994; Jin et al, 2022; Karşıdağ et al, 2011; Kesiktas et al, 2006; Lai et al, 1991; Lu et al, 2013; Manrique et al, 2018; Ninkovic et al, 2000; Osaki et al, 2022; Sengezer et al, 1997; Serel et al, 2006; Topalan & Ermis, 2001; Townsend, 1987; Turgut et al, 2010; Woo et al, 2006; Yu et al, 1983; Yu et al, 2012). In addition to soft tissue reconstruction, and in keeping with the first description of CLFF, authors such as Yu et al and Ciudad et al reported the inclusion of osseous components.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

Celie,

Guo,

Raya

et al. 2024

Microsurgery

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“…Regarding lower limb reconstructions, the conventional autonomization delay is considered to be slightly longer. Even if some authors have described earlier time points [71], the cross-leg flap is mostly divided after at least 4 weeks [15][16][17], even in the most recent case series [18,[72][73][74][75]. Modern technologies have brought interesting applications to the study of flap autonomization.…”

Section: Partmentioning

confidence: 99%

The Autonomization Principle in Vascularized Flaps: An Alternative Strategy for Composite Tissue Scaffold In Vivo Revascularization

Berkane,

Kostyra,

Chrelias

et al. 2023

Bioengineering

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Autonomization is a physiological process allowing a flap to develop neo-vascularization from the reconstructed wound bed. This phenomenon has been used since the early application of flap surgeries but still remains poorly understood. Reconstructive strategies have greatly evolved since, and fasciocutaneous flaps have progressively replaced muscle-based reconstructions, ensuring better functional outcomes with great reliability. However, plastic surgeons still encounter challenges in complex cases where conventional flap reconstruction reaches its limitations. Furthermore, emerging bioengineering applications, such as decellularized scaffolds allowing a complex extracellular matrix to be repopulated with autologous cells, also face the complexity of revascularization. The objective of this article is to gather evidence of autonomization phenomena. A systematic review of flap autonomization is then performed to document the minimum delay allowing this process. Finally, past and potential applications in bio- and tissue-engineering approaches are discussed, highlighting the potential for in vivo revascularization of acellular scaffolds.

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