Use of reverse sural artery cross leg flap for limb salvage in low resource setting: A case report and literature review.

Introduction: Soft tissue defect in the lower limb presents as a difficult reconstructive challenge. Cross-leg flap was routinely used in the past for the salvage of the lower limb but is seldom used nowadays due to advances in microsurgical procedures.

Case Presentation: We present a case of an 18-year-old male who presented with a complex soft tissue defect of 25 × 10 cm on the anterolateral aspect of the right leg following a motor vehicle accident. The defect was unsuitable for local flaps due to the unavailability of healthy tissue or free tissue transfer as no suitable recipient vessels were available for microvascular anastomosis in the vicinity. After serial debridement, the patient was planned for a distal cross-leg fasciocutaneous sural artery flap from the left leg to cover the defect. The cross-leg flap was elevated over the posterior aspect of the left leg with 2 delay procedures over 2 weeks and inset was done over the defect with an intact pedicle. External fixators were applied to fix the legs in a cross-leg position. Finally, the flap was detached after 3 weeks.

Discussion: Cross-leg flap has a clear role in reconstructive trauma surgery because of its simplicity, good-quality coverage, and minimal cosmetic disadvantage. We, therefore, advise its application in cases when microvascular competence or operating room time is limited, or the injury is not suitable for local tissue transfer.

Conclusion: A pedicled cross-extremity flap can be successfully employed for the salvage of the limb in a resource-limited setting.