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

Microsurgery

February 2024

Division of Plastic and Reconstructive Surgery, University of California Davis, School of Medicine, Sacramento, USA.

Background: Free 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.

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 Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg.

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Article Synopsis
  • Vascular injury rates following knee trauma range from 3.3% to 65%, highlighting the importance of rapid diagnosis and revascularization within 6-8 hours to prevent severe complications.
  • A case study details a delayed diagnosis of popliteal artery injury leading to ischemia, despite successful repair, creating challenges in limb reconstruction due to evolving ischemia and infection.
  • Ultimately, after multiple surgeries and the unsuccessful use of a free muscle flap, a cross-leg free flap technique was chosen as a potential solution for salvaging the limb.
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Background: Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or avulsion injuries. Management of lower leg defects is a complex problem, especially when they are large with deep soft tissue loss. These wounds are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels.

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Article Synopsis
  • Cross-leg free flaps are used to tackle large tissue defects when recipient blood vessels are not available, often utilizing a fasciocutaneous flap for better healing.
  • A study from 2010 to 2020 assessed patients who received this procedure, examining factors like age, defect size, and complications.
  • Results showed successful flap use with minimal complications; average recovery took about 9 months, suggesting the effectiveness of fasciocutaneous flaps in treating severe wounds.
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