Perforator-Based Pedicled Cross-Leg Flaps in Pediatric Patients

Abstract

Background Distal lower limb reconstruction is one of the most difficult and challenging tasks in plastic surgery. Despite the continuous advances in microsurgical techniques, pedicled cross-leg flaps still have a major role particularly in pediatric patients. Many techniques have been described to maximize the potential of the cross-leg flaps. The introduction of fasciocutaneous flaps has provided more potentials and made lower leg reconstruction easier and more successful. The description of perforator system in the leg has also made a revolution in the regional reconstruction. In this report, we present a new modification that increases the reach and facilitates the inset of the flaps. Methods The flap is taken from the posteromedial skin of the middle third of the leg. The design is determined by the location, size, and shape of the defect. The base of the flap should contain at least 2 perforators located by Doppler device. After elevation of the fasciocutaneous flap, 2 back cuts are performed in the upper and lower edge of the flap base preserving the 2 previously located perforators. Results Fifty patients, 32 males and 18 females, were reviewed and presented. Age of the patients ranged from 4 to 13 years and the defect size ranged from 20 to 130 cm. All flaps survived with 3 flaps had mild marginal ischemia, 2 flaps had mild infection, and 1 flap had partial dehiscence. Conclusions Back cuts made at the edges of the base of a cross-leg flap, preserving the feeding perforators, can increase the flap reach without jeopardizing its viability. It is also an easy to do technique and does not require any extra equipment or time.

Reliability and Safety of Cross-Leg Free Latissmus Dorsi Muscle Flap in Reconstruction of Mutilating Leg Injuries Using End-to-Side Anastomosis

“…Proximally based, and transverse or oblique laterally based cross-leg flaps have been described [21,22]. With better understanding of the anatomy of leg perforators, distally based and perforator based flaps became more frequent [23,24].…”

“…21,22 With a better understanding of the anatomy of leg perforators, distally based and perforator-based flaps became more frequent. 23,24 The continuous improvement of the outcomes of microsurgical interventions has made free flap reconstruction a routine option in lower extremity reconstructive surgery. 19 Successful free flap reconstruction of leg defects requires optimal flap choice, in addition to selecting appropriate recipient vessels in the leg.…”

“… 21 22 With a better understanding of the anatomy of leg perforators, distally based and perforator-based flaps became more frequent. 23 24 …”

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

“…We included published reports (original articles, randomized controlled trials, controlled clinical trials, retrospective or prospective observational studies, case reports, letters to the editor, comments, and technical descriptions) that provided data about early fasciocutaneous flap autonomization, free fasciocutaneous flap survival despite early failure of anastomoses, and fasciocutaneous flap survival after deliberate early division of the blood source in humans. The objective of this search was to report evidence of early autonomization when compared with the current timetable used in clinics, in order to leverage this principle to the optimum [6,16,[39][40][41].…”