Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

Cross-leg flaps: A nonmicrosurgical alternative treatment method in complex lower extremity trauma reconstruction

PDF Cite this article

Fatih Ilker Can

Department of Orthopedics and Traumatology, Muğla Training and Research Hospital, Muğla, Türkiye

ORCID: 0000-0001-5880-5336

Burak Şener

Department of Orthopedics and Traumatology, Muğla Training and Research Hospital, Muğla, Türkiye

ORCID: 0000-0002-5998-5807

Abstract

Objectives: This study aimed to present our experiences with cross-leg flap surgery, which demonstrates successful outcomes in lower limb soft tissue defects without the necessity of microsurgical intervention.

Patients and methods: The retrospective study included 26 patients (18 males, 8 females; mean age: 35.6±12.2 years; range, 18 to 65 years) between January 2015 and September 2019. A fasciocutaneous cross-leg flap was applied to the recipient extremity, and the extremities were immobilized by a tubular external fixator. Flap divisions were performed on the 21st postoperative day. At least two years of clinical outcomes were presented.

Results: Twenty-five flaps survived and recovered completely without any complication at the donor site, flaps, or the recipient area. In one diabetic patient, partial flap loss was encountered, which granulated with secondary healing. All patients demonstrated stable wound coverage, with none demanding additional soft tissue surgeries. All patients resumed normal ambulation and physical activity without any residual joint stiffness.

Conclusion: Cross-leg flap method is an effective and respectable option for extremity salvage as a good alternative to free flaps for the management of traumatic complex lower limb defects. This method is simple, provides abundant blood supply to the wound, and does not require microsurgical experience or a good working recipient artery.

Declarations

Ethics Committee Approval

The study protocol was approved by the Izmir Bakırçay University Non-invasive Clinical Research Ethics Committee (date: 17.01.2024, no: 1426). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

A written informed consent was obtained from each patient.

Author Contributions

Design, data collection and processing, analysis and interpretation, writing the article, references and fundings: F.İ.C.; Idea/concept, control/ supervision, literature review, critical review, materials: B.Ş.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. STARK RB. The cross-leg flap procedure. Plast Reconstr Surg (1946) 1952;9:173-204. DOI: 10.1097/00006534-195203000-00001.
  2. Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: A 10-year experience with 304 consecutive cases. J Trauma 1989;29:1086-94. DOI: 10.1097/00005373-198908000-00005.
  3. Lu L, Liu A, Zhu L, Zhang J, Zhu X, Jiang H. Cross-leg flaps: Our preferred alternative to free flaps in the treatment of complex traumatic lower extremity wounds. J Am Coll Surg 2013;217:461-71. DOI: 10.1016/j.jamcollsurg.2013.03.029.
  4. Francel TJ, Vander Kolk CA, Hoopes JE, Manson PN, Yaremchuk MJ. Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: Timing of coverage and long-term functional results. Plast Reconstr Surg 1992;89:478-87.
  5. Liang Yii RS, Chai SC, Zainal HM, Basiron N. Single-stage reconstruction of a traumatic tendocutaneous defect of the Achilles using free composite anterolateral thigh flap with vascularized fascia lata. Jt Dis Relat Surg 2022;33:673-9. DOI: 10.52312/jdrs.2022.843.
  6. Park S, Han SH, Lee TJ. Algorithm for recipient vessel selection in free tissue transfer to the lower extremity. Plast Reconstr Surg 1999;103:1937-48. DOI: 10.1097/00006534-199906000-00019.
  7. Nakatsuka T, Harii K, Asato H, Takushima A, Ebihara S, Kimata Y, et al. Analytic review of 2372 free flap transfers for head and neck reconstruction following cancer resection. J Reconstr Microsurg 2003;19:363-8. DOI: 10.1055/s2003-42630.
  8. Koul AR, Patil RK, Nahar S. Unfavourable results in free tissue transfer. Indian J Plast Surg 2013;46:247-55. DOI: 10.4103/0970-0358.118600.
  9. Agarwal P, Raza H. Cross-leg flap: Its role in limb salvage. Indian J Orthop 2008;42:439-43. DOI: 10.4103/0019-5413.43394.
  10. Van Boerum MS, Wright T, McFarland M, Fiander M, Pannucci CJ. Cross-leg flaps for lower extremity salvage: A scoping review. J Reconstr Microsurg 2019;35:505-15. DOI: 10.1055/s-0039-1679955.
  11. Gu YD, Zhang GM, Zhang LY, Li FG, Jiang JF. Clinical and experimental studies of cigarette smoking in microvascular tissue transfers. Microsurgery 1993;14:391-7. DOI: 10.1002/micr.1920140608.
  12. Baux GS, Fischer E, McCarthy JG. Frank Hastings Hamilton: A pioneer American plastic surgeon. Plast Reconstr Surg 2004;114:1240-7. DOI: 10.1097/01.prs.0000135860.35203.b7.
  13. Long CD, Granick MS, Solomon MP. The crossleg flap revisited. Ann Plast Surg 1993;30:560-3. DOI: 10.1097/00000637-199306000-00018.
  14. Sharma RK, Kola G. Cross leg posterior tibial artery fasciocutaneous island flap for reconstruction of lower leg defects. Br J Plast Surg 1992;45:62-5. DOI: 10.1016/0007-1226(92)90119-i.
  15. Atik OŞ. Writing for Joint Diseases and Related Surgery (JDRS): There is something new and interesting in this article! Jt Dis Relat Surg 2023;34:533. DOI: 10.52312/jdrs.2023.57916.