How does a pure muscle cross-leg flap survive? An unusual salvage procedure reviewed.

An exceptional indication for a cross-leg gastrocnemius flap used as a pure muscle flap in the distal third of the lower leg is presented. The vascular status of the patient after the accident and extensive colonized wounds in the injured lower leg did not favor any microvascular reconstruction. Because no cross-leg muscle flap has been mentioned in the literature so far, technical details of the procedure are explained. This case report leads to a discussion of the principles of wound healing in cross-leg muscle flaps as an example for early loss of axial blood supply. Furthermore, it adds new variety to the numerous procedures that use the gastrocnemius flap.