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- Title
Use of the cross-leg distally based sural artery flap for the reconstruction of complex lower extremity defects.
- Authors
Weihao Liang; Bien Keem Tan
- Abstract
Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.
- Subjects
PERFORATOR flaps (Surgery); LEG; FREE flaps; ARTERIES; PRESSURE ulcers; SURGICAL flaps
- Publication
Archives of Plastic Surgery, 2019, Vol 46, Issue 3, p255
- ISSN
2234-6163
- Publication type
Article
- DOI
10.5999/aps.2017.00892